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2. Headache Classification Committee of the report of a patient with triptan responsive International Headache Society The Inter- national Classification of Headache Dis- orders. Cephalalgia 2004; 24: 1–160.
3. Relja G, Zorzon M, Locatelli L, Carraro N, istered on an open-label basis; (2) frova- cervical and intracranial vessels and the triptan was effective only two times; and history gave no indication of migraine or consider our finding valid because (1) no cations usually effective; and (2) dihydro- treatment. Neurology 2003; 60: 905–909.
5. Katsarava Z, Diener HC, Limmroth V.
the mode of action with triptans, had been Medication overuse headache: a focus onanalgesics, ergot alkaloids and triptans.
effective. Differential diagnoses include (1) unsuccessful, making this case atypical.
Buzzi G. Subcutaneous sumatriptan induces and first-line medication were ineffective; (2) obstructive sleep apnea syndrome, for after the application of rizatriptan. Fur- 7. Bendtsen L, Mattsson P, Zwart J-A, Lipton RB. Placebo response in clinical randomized not be ruled out since the patient did not trials of analgesics in migraine. Cephalalgia pressure, not requiring further medication.
To avoid potential long-term side effects heterocroniaÕ is unlikely, because there is associated with the frequent use of trip- sponse in cluster headache trials: a review.
hypnic headache (ÔÔalarm clockÕÕ) headache syndrome. Cephalalgia 1998; 18: 152–156.
teristics with neuro-vascular cephalalgias.
10. Ghiotto N, Sances G, Di Lorenzo G, et al.
Report of eight new cases of hypnic head- reduction in intensity. On pain nights she ache and mini-review of the literature.
Functional Neurology 2002; occasionally rizatriptan with success.
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hyperintensities in the caudate nuclei and putamina predominating on the right side.
sive ataxia, visual disturbances and epi- after the onset of the disease. Neuropath- first the left hand before spreading to the icking an hemidystonia. She also had left France (tel.: +33 2 32 88 87 40; fax: +33 malformation involving the striatopallidal complex, particularly the putamen [1].
Keywords: hemidystonia, Creutzfeldt–Jacob disease, basal ganglia Ó 2006 EFNS European Journal of Neurology 13, 666–672 myoclonus, dystonia, choreoathetosis [2], ganglia (BG) in most of the patients with clinical parkinsonian syndromes, i.e.
presenting as corticobasal degeneration [3] mutation) with supranuclear palsy. JAMA1992; 268: 2413–2415.
5. Hellmann MA, Melamed E. Focal dystonia as the presenting sign in Creutzfeldt–Jakob disease. Movement Disorders 2002; 17: 1097– affect 0.5–5% of the cases, and are often loss in the BG correlated with the gener- alized dystonia observed during the final 6. Sethi KD, Hess DC. Creutzfeldt–Jakob dystonia is however rare, generally focal disease presenting with ataxia and a move- ment disorder. Movement Disorders 1991; 6: 7. Anschell DJ, Simon DK, Llinas R, Joseph generalized dystonia occur during the later 8. Schro¨ter A, Zerr I, Henkel K, Tschampa Editor, for his valuable advice in editing resonance imaging in the clinical diagnosis of Creutzfeldt-Jakob disease. Archives of thalami and pallidi [8]. Dystonia observed 9. Lehericy S, Vidailhet M, Dormont D, et al.
after striatopallidal lesions are character- 1. Chuang C, Fahn S, Frucht SJ. The natural Striatopallidal and thalamic dystonia: an ized by sustained spasms whereas dystonia dystonia: report of 33 cases and review of occurring after thalamic lesion are asso- the literature. Journal of Neurology, Neuro- surgery and Psychiatry 2002; 72: 59–67.
spongiform encephalopathy (Creutzfeldt– predominating in the hand [9]. In our case 2. McKee D, Talbot P. Chorea as a presenting Jakob disease). The nature and progression left hemidystonia was correlated with the of spongiform change. Brain 1978; 101: 333– disease. Movement Disorders 2003; 18: 837– 11. Oberndorfer S, Urbanits S, Lahrmann H, 3. Litvan I, Agid Y, Goetz C, et al. Accuracy Jarius C, Albrecht G, Grisold W. Familial commonly affected by CJD lesions [10].
of the clinical diagnosis of corticobasal Creutzfeldt–Jakob disease initially present- degeneration: a clinicopathologic study.
ing with alien hand syndrome. Journal ofNeurology 2002; experimental evidence of the effect of he- phyria during pregnancy in a patient with [3]. We accept that there is little published in pregnancy, but had the clinicians con- tacted the manufacturer of haem- arginate Immunology,Cardiff University, Cardiff, never needed to resort to this drastic ac- phrase Ôcould only be treated successfully by an induced abortionÕ as all the patients we have dealt with have been successfully treated with haem-arginate. Indeed several of these patients have had repeated cour- attacks, with no apparent adverse effect disorder. The published results in this case on the foetus. The authors state that this are difficult to interpret because of the use of mass units and the absence of reference values. In addition, protoporphyrin is not excreted in urine as a result of its hydo- drug with a reference to a review [2]. This phobicity and it is difficult to see how this is a misrepresentation of the article which fetotoxic effects are unknown and quotes of acute porphyria and this article high- Ó 2006 EFNS European Journal of Neurology 13, 666–672


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