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JKM > Volume 37(3); 2016 > Article
Cha, Heo, Yoo, Kim, Seol, and Jo: A Case of Combined Korean-Western Medicine Treatment on Chorea Hyperglycemia Basal Ganglia Syndrome Induced by Nonketotic Diabetes Mellitus

Abstract

Objectives

Chorea Hyperglycemia Basal Ganglia Syndrome(C-H-BG) is a syndrome with chorea-ballismus induced by hyperglycemia. This case study reports the clinical effect of Korean medicine treatment on C-H-BG.

Methods

A 73-year-old male patient with left side chorea-ballismus visited Daejeon Korean Medicine Hospital. He had no diabetes mellitus(DM) history but the laboratory test result suggested nonketotic DM. We diagnosed him as C-H-BG and treated with herbal medicine, acupuncture and hyperglycemic medication. To evaluate chorea-ballismus, we checked Abnormal Involuntary Movement Scale(AIMS) score everyday.

Results

After 14 days of treatment, the chorea-ballismus improved and AIMS score decreased from 38 to 4. Gait disturbance caused by the symptom disappeared.

Conclusions

We suggest that Korean medicine treatment can improve the symptom of C-G-BG.

Fig. 1
Brain MRI
(A) T1-Weighted image of basal ganglia(BG) and striatum. Old lacunar infarctions of both BG are seen.
(B) T2-Weighted image of BG and striatum. Old lacunar infarctions of both BG are seen.
(C) Old lacunar infarctions of right PVWM are seen on T1-Weighted image.
jkm-37-3-131f1.gif
Fig. 2
Improvement of AIMS score
jkm-37-3-131f2.gif
Table 1
Vital Sign and Laboratory Test at Admission
Vital sign* 130/80-68-20-36.2
Laboratory test Normal limit

Blood sugar test (mg/dl) 628 140–200
Fasting Blood Sugar (mg/dl) 237 80~100
HbA1c (%) 11.8 4.0~6.2
Triglyceride (mg/dl) 201 36~165
HDL-Cholesterol (mg/dl) 34.5 40~70
ɣ-GTP (IU/L) 69 0~64
Total protein (g/dl) 6.1 6.4~8.3
Albumin (g/dl) 3.5 3.8~5.1
Total Bilirubin (mg/dl) 1.4 0.1~1.2
WBC (/μℓ) 12700 4500~11000
ESR (mm/hr) 11 0~10
Urine Glucose +++
Urine Leukocyte ++

H high, L low, +++ severe, ++ moderate, + mild, - non-existed

* Vital sign is written in blood pressure (mmHg) - pulse rate - respiratory rate - body temperature(°C).

Table 2
Composition of Shihogayonggolmoryo-tang
Scientific name Amount(g)
Bupleuri Radix 8
Pinelliae Rhizoma 6
Rhei Radix et Rhizoma 4
Fossilia Ossis Mastodi 4
Ostreae Testa 4
Cinnamomi Ramulus 4
Poria Sclerotium 4
Zingiberis Rhizoma Recens 4
Zizyphi Fructus 4
Ginseng Radix Palva 4
Scutellariae Radix 4
Poria Sclertum cum Pini Radix 4
Table 3
Abnormal Involuntary Movement Scale(AIMS)
Facial and Oral Movements Muscles of Facial Expressions 0 1 2 3 4
Lips and Perioral Area 0 1 2 3 4
Jaw 0 1 2 3 4
Tongue 0 1 2 3 4

Extremity Movements Upper (arms, wrists, hands, fingers) 0 1 2 3 4
Lower (legs, knees, ankles, toes) 0 1 2 3 4

Trunk Movements Neck, Shoulders, Hips 0 1 2 3 4

Global judgement Severity of abnormal movements overall 0 1 2 3 4
Incapacitation due to abnormal movements 0 1 2 3 4
Patient’s awareness of abnormal movements 0 1 2 3 4

Dental status Current problems with teeth/or dentures YES/NO
Are dentures usually worn? YES/NO
Endentia? YES/NO

Do movements disappear with sleep? YES/NO

0=None, 1=Minimal, 2:Mild, 3:Moderate, 4:Severe

Table 4
Improvement of Abnormal Involuntary Movement Scale(AIMS) and Sleeping Hours
Day 1 Day 2 Day 6 Day 10 Day 14
AIMS (score) Facial & oral movements 16 13 15 6 1
Extremity movements 7 5 7 3 1
Trunk movements 4 4 4 2 1
Global judgement 11 10 9 4 1

Total AIMS 38 32 35 15 4

Sleeping hours (hrs) 4 4 5 6 7

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