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Substance abuse and movement disorders


  • John C.M. Brust MD

    Corresponding author
    1. Department of Neurology, Harlem Hospital Center and Columbia, University College of Physicians and Surgeons, New York, New York, USA
    • Department of Neurology, Harlem Hospital Center, 506 Lenox Avenue, New York, NY 10037
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  • Potential conflict of interest: None reported.


An array of movement disorders is associated with ethanol, illicit drugs, and tobacco. Heavy ethanol users experience withdrawal tremor and, less often, withdrawal parkinsonism, chorea, and myoclonus. Asterixis is a feature of hepatic failure. On the other hand, ethanol can ameliorate essential tremor and myoclonus-dystonia. Among opioid drugs, meperidine can precipitate myoclonus. Severe parkinsonism affected users of a synthetic meperidine analog contaminated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Spongiform leukoencephalopathy, sometimes with chorea and myoclonus, occurred in inhalers of heroin vapor (chasing the dragon). Psychostimulants including cocaine acutely cause stereotypies and dyskinesias. Phencyclidine toxicity causes myoclonus. Tobacco use, on the other hand, protects against Parkinson's disease. Clinicians need to consider substance abuse in patients with unexplained movement disorders. © 2010 Movement Disorder Society.

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