New Observations Letters

Reply #2 to: Glycemic Choreoballism

Authors: {'first_name': 'Ujjawal', 'last_name': 'Roy'},{'first_name': 'Shyamal Kumar', 'last_name': 'Das'},{'first_name': 'Adreesh', 'last_name': 'Mukherjee'},{'first_name': 'Debsadhan', 'last_name': 'Biswas'},{'first_name': 'Koushik', 'last_name': 'Pan'},{'first_name': 'Atanu', 'last_name': 'Biswas'},{'first_name': 'Ajay', 'last_name': 'Panwar'}


Keywords: Hemichorea hemiballismhyperglycemiainfarct 
 Accepted on 29 Oct 2016            Submitted on 27 Oct 2016

Dear Editor,

This is in reply to a letter written by Dokyung Lee and Tae-Beom Ahn with reference to two articles related to glycemic choreoballism (gCB) published in your journal.1,2

It is accurate that the clinical outcome of gCB is variable, although the majority of the literature states that it is a treatable disorder with a good prognosis.35

However, the diagnostic criteria for gCB would be incomplete unless we exclude other causes of hemichorea hemiballism (HCHB).

Management of gCB is mainly based on controlling blood sugar levels, but dopamine receptor blocking agents are often essential. Here, we again want to highlight that hyperglycemia can result in an ischemic penumbra and reversible clinical syndrome/neuroimaging abnormalities in patients with HCHB; however, prolonged hyperglycemia may result in true infarction with an irreversible clinical syndrome.6 In summary, a better understanding of gCB requires further research into the pathogenic mechanisms of this disease, which may also aid in its proper management.


1 Funding: None. 

2 Financial Disclosures: None. 

3 Conflict of Interest: The authors report no conflict of interest. 

4 Ethics Statement: Not applicable for this category of article. 


  1. Cosentino, C Torres, L Nuñez, Y et al. (2016). Hemichorea/hemiballism associated with hyperglycemia: report of twenty cases. Tremor Other Hyperkinet Mov, : 6. doi: 10.7916/D8DN454P. 

  2. Roy, U Das, SK Mukherjee, A et al. (2016). Irreversible hemichorea–hemiballism in a case of nonketotic hyperglycemia presenting as the initial manifestation of diabetes mellitus. Tremor Other Hyperkinet Mov, : 6. doi: 10.7916/D8QZ2B3F. 

  3. Lai, PH Tien, RD Chang, MH et al. (1996). Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus. AJNR Am J Neuroradiol 17: 1057–1064. [PubMed]  

  4. Piccolo, I, Defanti, CA, Soliveri, P, Volontè, MA, Cislaghi, G and Girotti, F (2003). Cause and course in a series of patients with sporadic chorea. J Neurol 250: 429–435. doi: 10.1007/s00415-003-1010-7. [PubMed]  

  5. Ray, S, Howlader, S, Chakraborty, S, Chakraborty, PP and Ghosh, S (2015). Hemichorea-hemiballism as the first presentation of type 2 diabetes. Clin Diabetes 33: 87–89. doi: 10.2337/diaclin.33.2.87. [PubMed]  

  6. Tung, CS, Guo, YC, Lai, CL and Liou, LM (2010). Irreversible striatal neuroimaging abnormalities secondary to prolonged, uncontrolled diabetes mellitus in the setting of progressive focal neurological symptoms. Neurol Sci 31: 57–60. doi: 10.1007/s10072-009-0127-6. [PubMed]