A Case of Combined Korean-Western Medicine Treatment on Chorea Hyperglycemia Basal Ganglia Syndrome Induced by Nonketotic Diabetes Mellitus

Jiyun Cha; Jong-won Heo; Ho-ryong Yoo; Yoon-sik Kim; In-chan Seol; Hyun-kyung Jo; Cha, Jiyun; Heo, Jong-won; Yoo, Ho-ryong; Kim, Yoon-sik; Seol, In-chan; Jo, Hyun-kyung

doi:10.13048/jkm.16041

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

Case Report

The Journal of Korean Medicine 2016; 37(3): 131-138.

Published online: September 30, 2016

DOI: https://doi.org/10.13048/jkm.16041

A Case of Combined Korean-Western Medicine Treatment on Chorea Hyperglycemia Basal Ganglia Syndrome Induced by Nonketotic Diabetes Mellitus

Jiyun Cha, Jong-won Heo, Ho-ryong Yoo, Yoon-sik Kim, In-chan Seol, Hyun-kyung Jo

Dept. of Internal Medicine, College of Korean Medicine, Daejeon University

Correspondence to: 조현경 (Hyun-kyung Jo), 대전광역시 중구 대흥로 176-9 대전대학교 한방병원, Tel: +82-42-229-6924, Fax: +82-42-254-3403, E-mail: brillijo@dju.kr

Received August 24, 2016 Revised September 25, 2016 Accepted September 25, 2016

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.

Keywords: Chorea Hyperglycemia Basal Ganglia Syndrome, Chorea, Dyskinesia, Hyperglycemia, Korean medicine

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.

Fig. 2

Improvement of AIMS score

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
Extremity Movements	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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