PEMOLINE INDUCED ACUTE CHOREOATHETOSIS - CASE-REPORT AND REVIEW OF THE LITERATURE

Background: Pemoline is an oxazolidine derivative that is structurally different from amphetamines and used in the treatment of attention de ficit disorder. Pemoline has not been commonly associated in the liter ature as a cause of acute movement disorders. The following case descr ibes two children acutely poisoned with pemoline who experienced profo und choreoathetosis. Case Report: Two, 3-year-old male, identical twin siblings presented to the emergency department after found playing wi th a an empty bottle of pemoline originally containing 59 tablets. The children had a medical history significant for attention deficit diso rder previously treated with methylphenidate without success. This was their first day of pemoline therapy. The choreoathetoid movements beg an 45 min to 1 h after ingestion. The children gave no history of prio r movement disorders and there was no family history of movement disor ders. The children received gastrointestinal decontamination and high doses of intravenous benzodiazepines in an attempt to control the chor eoathetoid movements. Despite treatment, the children continued to hav e choreoathetosis for approximately 24 hours. Forty-eight hours after admission, the children appeared to be at their baseline and were disc harged home. Conclusion: Pemoline associated movement disorder has bee n rarely reported in the acute toxicology literature, The possibility of choreoathetoid movements should be considered in patients presentin g after pemoline overdose.