Uncommon Movement Disorders in Chronic Hepatic Disease with Response to Rifaximin

  • Ana L. Sousa
  • Paula Salgado
  • José E. Alves
  • Sara Silva
  • Sofia Ferreira
  • Marina Magalhães


Background: Chronic hepatic disease can present with extrapyramidal symptoms. We describe two cases that presented with highly unusual movement disorders: ballism and gait freezing.

Case report: Patient 1 is a 42-year-old man with previous episodes of hepatic encephalopathy (HE) who presented with upper limb dystonia and generalized chorea that progressed to ballism. Patient 2 is a 55-year-old woman who presented with pronounced gait freezing. In both patients, features of HE and acquired hepatocerebral degeneration coexisted. They improved markedly, though transiently, with rifaximin.

Discussion: Ammonia-reducing treatments should be considered in patients presenting with movement disorders due to chronic liver disease.

Keywords: Hepatic disease, ballism, freezing, rifaximin

Citation: Sousa AL, Salgado P, Alves JE, Silva S, Ferreira S, Magalhães M. Uncommon movement disorders in chronic hepatic disease with response to rifaximin. Tremor Other Hyperkinet Mov. 2019: 9. doi: 10.7916/tohm.v0.649.