Chorea associated with gabapentin use in an elderly man

Abstract

Background: Chorea is a hyperkinetic movement disorder characterized by irregular, flowing, nonstereotyped, random, involuntary movements. Huntington disease (HD) and drug-induced chorea account for >50% of adult-onset cases. Chorea associated with gabapentin, an anticonvulsant, has not been well documented. Objective: The purpose of this article was to report a case of chorea that developed in an elderly man being treated with gabapentin for severe anxiety. Case summary: A 75-year-old white man (height, 165.1 cm; weight, 65.8 kg; body mass index, 19.6 kg/m2) with anxiety disorder not otherwise specified was admitted to a geriatric medicine psychiatric unit in Connecticut because of worsening symptoms of anxiety affecting his cognitive ability. On evaluation, the patient had choreiform movements involving the neck, trunk, upper and lower extremities, and tongue. The patient reported that symptoms began after taking gabapentin 300 mg PO TID (prescribed by his geriatrician) for the treatment of anxiety. The patient had been taking gabapentin for >1 month when the symptoms first appeared. There was no known family history of HD, and patient workup was unremarkable for other conditions (eg, vascular disease of the brain, progressive dementia, infectious and metabolic disorders) that might present with chorea. The chorea lasted for ~4 months and resolved within 2 days after gabapentin discontinuation. Conclusion: This article reports a case of chorea in an elderly patient who was receiving gabapentin for the treatment of anxiety. After gabapentin discontinuation, the chorea resolved completely, indicating a probable adverse drug reaction.