ABSTRACTBackgroundAmantadine is a widely prescribed medication in Parkinson's disease (PD). A distinctive craniofacial distribution of myoclonus with speech impairment is an underrecognized iatrogenic complication in amantadine‐treated patients with PD.CasesWe report 7 patients with idiopathic PD (disease duration, 6–21 years) who developed speech‐induced craniofacial‐predominant myoclonus with “stuttering‐like” dysarthria and speech arrests days to months after amantadine initiation or dose increase. Renal insufficiency was identified as a risk factor in 4 cases. In all cases, reduction or discontinuation of amantadine markedly attenuated the myoclonus and restored speech intelligibility.Literature ReviewAmantadine can induce subcortical segmental or generalized myoclonus. A report in 1996 of “vocal myoclonus” in an amantadine‐treated patient with PD was the first observation of a focal distribution of myoclonus, particularly affecting speech. Since then, few cases of craniofacial myoclonus with speech impairment have been reported, none with accompanying video. With 1 exception, the craniofacial distribution was part of a generalized pattern of amantadine‐induced myoclonus. Comorbid renal insufficiency is a recognized risk factor.ConclusionsSpeech‐induced craniofacial myoclonus, with marked “stuttering‐like” dysarthria and speech arrests, is a disabling iatrogenic complication in PD that resolves upon amantadine discontinuation.

More from our Archive

• DOI: 10.1001/jamaneurol.2023.1988 2023

  Mapping Lesion-Related Epilepsy to a Human Brain Network

  Frederic L. W. V. J. Schaper, Janne Nordberg, Alexander L. Cohen, Christopher Lin, Joey Hsu, Andreas Horn, Michael A. Ferguson, Shan H. Siddiqi, William Drew, Louis Soussand, Anderson M. Winkler, Marta Simó, Jordi Bruna, Sylvain Rheims, Marc Guenot, Marco Bucci, Lauri Nummenmaa, Julie Staals, Albert J. Colon, Linda Ackermans, Ellen J. Bubrick, Jurriaan M. Peters, Ona Wu, Natalia S. Rost, Jordan Grafman, Hal Blumenfeld, Yasin Temel, Rob P. W. Rouhl, Juho Joutsa, Michael D. Fox

• DOI: 10.1093/brain/awad236 2023

  Addressing the gaps between socioeconomic disparities and biological models of dementia

  Agustín Ibáñez, Agustina Legaz, Manuel Ruiz-Adame

• DOI: 10.1111/dmcn.15689 2023

  From cryogenic to on‐scalp magnetoencephalography for the evaluation of paediatric epilepsy

  Odile Feys, Xavier De Tiège

• DOI: 10.1093/brain/awad238 2023

  Neurologic complications in herpes simplex encephalitis: clinical, immunological and genetic studies

  Thaís Armangué, Gemma Olivé-Cirera, Eugenia Martínez-Hernandez, Maria Rodes, Vicente Peris-Sempere, Mar Guasp, Raquel Ruiz, Eduard Palou, Azucena González, Ma Ángeles Marcos, María Elena Erro, Luis Bataller, Íñigo Corral-Corral, Jesus Planagumà, Eva Caballero, Alexandru Vlagea, Jie Chen, Paul Bastard, Marie Materna, Astrid Marchal, Laurent Abel, Aurélie Cobat, Laia Alsina, Clàudia Fortuny, Albert Saiz, Emmanuel Mignot, Adeline Vanderver, Jean-Laurent Casanova, Shen-Ying Zhang, Josep Dalmau

• DOI: 10.1093/brain/awad240 2023

  Normal and pathogenic variation of <i>RFC1</i> repeat expansions: implications for clinical diagnosis

  Natalia Dominik, Stefania Magri, Riccardo Currò, Elena Abati, Stefano Facchini, Marinella Corbetta, Hannah Macpherson, Daniela Di Bella, Elisa Sarto, Igor Stevanovski, Sanjog R Chintalaphani, Fulya Akcimen, Arianna Manini, Elisa Vegezzi, Ilaria Quartesan, Kylie-Ann Montgomery, Valentina Pirota, Emmanuele Crespan, Cecilia Perini, Glenda Paola Grupelli, Pedro J Tomaselli, Wilson Marques, J C Ambrose, P Arumugam, E L Baple, M Bleda, F Boardman-Pretty, J M Boissiere, C R Boustred, H Brittain, M J Caulfield, G C Chan, C E H Craig, L C Daugherty, A de Burca, A Devereau, G Elgar, R E Foulger, T Fowler, P Furió-Tarí, E Gustavsson, J M Hackett, D Halai, A Hamblin, S Henderson, J E Holman, T J P Hubbard, K Ibáñez, R Jackson, L J Jones, D Kasperaviciute, M Kayikci, L Lahnstein, K Lawson, S E A Leigh, I U S Leong, F J Lopez, F Maleady-Crowe, J Mason, E M McDonagh, L Moutsianas, M Mueller, N Murugaesu, A C Need, C A Odhams, C Patch, D Perez-Gil, D Polychronopoulos, J Pullinger, T Rahim, A Rendon, P Riesgo-Ferreiro, T Rogers, M Ryten, B Rugginini, K Savage, K Sawant, R H Scott, A Siddiq, A Sieghart, D Smedley, K R Smith, A Sosinsky, W Spooner, H E Stevens, A Stuckey, R Sultana, E R A Thomas, S R Thompson, C Tregidgo, A Tucci, E Walsh, S A Watters, M J Welland, E Williams, K Witkowska, S M Wood, M Zarowiecki, Joseph Shaw, James Polke, Ettore Salsano, Silvia Fenu, Davide Pareyson, Chiara Pisciotta, George K Tofaris, Andrea H Nemeth, John Ealing, Aleksandar Radunovic, Seamus Kearney, Kishore R Kumar, Steve Vucic, Marina Kennerson, Mary M Reilly, Henry Houlden, Ira Deveson, Arianna Tucci, Franco Taroni, Andrea Cortese,

• DOI: 10.1002/mus.27853 2023

  Continued benefit of nusinersen initiated in the presymptomatic stage of spinal muscular atrophy: 5‐year update of the<scp>NURTURE</scp>study

  Thomas O. Crawford, Kathryn J. Swoboda, Darryl C. De Vivo, Enrico Bertini, Wuh‐Liang Hwu, Richard S. Finkel, Janbernd Kirschner, Nancy L. Kuntz, Aledie Navas Nazario, Julie A. Parsons, Astrid Pechmann, Monique M. Ryan, Russell J. Butterfield, Haluk Topaloglu, Tawfeg Ben‐Omran, Valeria A. Sansone, Yuh‐Jyh Jong, Francy Shu, Cong Zhu, Stephanie Raynaud, Tiffany R. Lago, Angela D. Paradis, Richard Foster, Russell Chin, Zdenek Berger,

• DOI: 10.1111/ene.15964 2023

  Collaborative plasma biomarkers for Parkinson disease development and progression: A cross‐sectional and longitudinal study

  Yang Jiao, Xue Zhu, Xinyi Zhou, Yuanyuan Li, Liche Zhou, Aonan Zhao, Ningdi Luo, Mengyue Niu, Jun Liu

• DOI: 10.1161/strokeaha.123.043672 2023

  Differences in Stroke Recurrence Risk Between Atrial Fibrillation Detected on ECG and 14-Day Cardiac Monitoring

  Alonso Alvarado-Bolaños, Diana Ayan, Alexander V. Khaw, Lauren M. Mai, Jennifer L. Mandzia, Chrysi Bogiatzi, Marko Mrkobrada, Maria Bres-Bullrich, Lorraine A. Fleming, Corbin Lippert, Sebastian Fridman, Luciano A. Sposato

• DOI: 10.1111/head.14597 2023

  Aura phenomena do not initiate migraine attacks—Findings from neuroimaging

  Jan Mehnert, Laura Fischer‐Schulte, Arne May

• DOI: 10.1093/brain/awad239 2023

  Neurophysiological mechanisms of deep brain stimulation across spatiotemporal resolutions

  Wolf-Julian Neumann, Leon A Steiner, Luka Milosevic