A 75-year-old woman was prescribed pimozide 2 mg twice a day 4 years previously for paranoid behavior. The patient developed involuntary movements in her abdomen following abrupt discontinuation of pimozide.
The movement was brief, involuntary, nonsuppressible, and jerk-like, associated with an audible sniff (video 1). These movements did not affect the patient’s respiration and disappeared while she was eating or sleeping. The diagnosis of tardive diaphragmatic tremor was made, and the patient was started back on pimozide 2 mg twice a day. A very low dose of clonazepam was added and pimozide was gradually discontinued. At the time of the follow-up visit, the movements had disappeared (video 2).
Video 1
Brief, involuntary, nonsuppressible, inspiratory, and jerk-like movements in the abdomen associated with an audible sniff.Download Supplementary Video 1 via http://dx.doi.org/10.1212/008761_Video_1
Video 2
BResolution of the movements following a gradual discontinuation of pimozide and addition of clonazepam.Download Supplementary Video 2 via http://dx.doi.org/10.1212/008761_Video_2
Diaphragmatic movements as a part of withdrawal dyskinesia have been described.1 In cases where this movement is seen in isolation without respiratory compromise, the term diaphragmatic tremor is preferred.2
Study funding
No targeted funding reported.
Disclosure
H.V. Gupta reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Footnotes
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Teaching slides links.lww.com/WNL/B26
- © 2020 American Academy of Neurology
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