JMD

https://doi.org/10.14802/jmd.18055 / J Mov Disord 2019;12(2):128-129

pISSN 2005-940X / eISSN 2093-4939

LETTER TO THE EDITOR

Recurrent Belly Dancer’s Dyskinesia

with Pregnancy
Belal Aldabbour, Islam E’Leimat, Kefah Alhayek, Aiman Momani
Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan

Dear Editor,
Belly dancer’s dyskinesia (BDD) is a rare disorder character-
ized by visible, involuntary, slow, semicontinuous, undulating
abdominal wall movements. BDD typically affects the abdomi-
nal muscles, but can also involve both the hemidiaphragm and
perineal muscles. BDD in pregnancy is even rarer, as a literature
review yielded only 3 reported cases.1
A 40-year-old woman, during her 40th week of pregnancy,
presented with a one-week history of writhing, involuntary ab-
dominal movements that started gradually and involved the
anterior abdominal muscles. The abdominal movements were
semirhythmic, painless, rolling contractions that mostly started
from the lower right side of the abdomen and moved upwards
and to the left, which resulted in undulating movements of the
umbilicus. Movements were slow, brief, and repetitive, and re-
curred throughout the day at different frequencies that varied
from 1–2 per minute to 3–4 repetitions per hour. These move-
ments did not affect the patient’s breathing pattern or depth of
breath. There were no specific precipitating or alleviating fac-
tors, and the patient was unable to voluntarily suppress the con-
tractions. Distraction techniques did not significantly alter the
frequency of the movements, and the movements did not re-
spond to changes in the patient’s position or to breathing exer-
cises, such as breath-holding or counting routines. The move-
ments also did not subside during sleep. The patient reported
an episode of depression two years prior to the onset of her cur-
rent symptoms, for which she had refused medical treatment.
She denied any history of trauma, spinal or abdominal surger-
ies, or personal or family history of similar episodes. Her eight
Received: October 24, 2018 Revised: December 12, 2018 Accepted: January 28, 2019
Corresponding author: Belal Aldabbour, MD
Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), P.O. Box 630001, Irbid
22110, Jordan / Tel: +962-2-7200600 / Fax: +962-2-709577 / E-mail: belal90md@gmail.com
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/
previous pregnancies all ended with normal vaginal births. Drug
history was unremarkable. Neurological and gynecological ex-
aminations were normal, except for the abdominal movements.
There were no signs of fetal distress. Basic laboratory tests
showed iron deficiency anemia with normal folate and vitamin
B12 levels. Serum electrolytes, kidney, and thyroid function tests
were normal. A clinical diagnosis of BDD was made. A normal
vaginal birth, 2 days later, resulted in a healthy baby. A postpar-
tum MRI of the thoracic spine was unrevealing.
Upon discharge, the patient refused pharmacologic therapy
for dyskinesia. At a 2-month follow-up visit, the patient reported
persistence of her symptoms and requested better symptomatic
control. Clonazepam 0.5 mg three times a day was prescribed.
After four weeks of drug therapy, the patient reported near-com-
plete resolution of her symptoms, with greater than an 80% re-
duction in the frequency of the abdominal muscle movement
episodes. However, two months later, the patient complained of a
relapse of her symptoms, where abnormal movements occurred
at almost the same frequency as at the first presentation. She also
reported missing her period. A serum-based pregnancy test
showed that the patient was pregnant. The daily dose of clonaze-
pam was gradually increased to 2 mg twice a day, which achieved
a near-complete remission. Consent was obtained from the sub-
ject, and the case report was approved by the Ethics Committee
of the King Abdullah University Hospital.
Iliceto et al.2 theorized that a dysfunction of inhibitory spinal
interneurons, or a structural reorganization of local neuronal
circuits may be the underlying pathophysiology of BDD. A
long list of potential causes has been postulated. Dyskinesia may

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128 Copyright © 2019 The Korean Movement Disorder Society


be secondary to a structural lesion, such as a syringomyelia, my-
elitis, spinal cord trauma, vascular lesion or malignancy.3 Dyski-
nesia also may be due to spinal segmental myoclonus.4 Meta-
bolic causes, drugs, or other functional etiologies have also been
postulated. In our case, laboratory and radiology examinations
failed to identify a definitive etiology.
Some previous manuscripts suggest that local compressive or
hemodynamic changes in the thoracic cord or roots from a
gravid uterus is a possible etiology in pregnancy5; however, this
hypothesis may not explain the relapse that our patient experi-
enced during the first few weeks of the following pregnancy as it
was too early to be explained by a gravid uterus (less than 8 weeks
pregnant).
The pattern of the presenting symptoms was less consistent
with chorea gravidarum as it typically manifests with irregular,
nonrhythmic, and jerky movements that usually involve the
limbs. Our diagnosis of BDD was further supported by the lack
of symptom resolution, shortly after, or within weeks of delivery.
A further distinction between BDD and chorea gravidarum is
the possibility of symptoms continuing during sleep in BDD.6
The management of BDD is challenging. Current treatment
paradigms remain based on anecdotal evidence. Clonazepam
and levetiracetam have both been reported to be effective.7 Our
Recurrent Belly Dancer’s Dyskinesia with Pregnancy
Aldabbour B, et al.
patient achieved a near-complete resolution of the dyskinesia
with clonazepam. Increases to the dose were required to improve
her recurrent symptoms after becoming pregnant again.
Conflicts of Interest
The authors have no financial conflicts of interest.
ORCID iD
Belal Aldabbour https://orcid.org/0000-0001-9186-4039
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