This report describes a rare case of respiratory dyskinesia in a patient with vascular parkinsonism that was successfully controlled with clotiazepam. An 89-year-old man with a history of vascular parkinsonism presented with dyspnea and irregular breathing associated with marked orofacial and truncal dyskinesia. These symptoms became prominent following the upward titration of a ropinirole patch to 24 mg/day. Although mirtazapine was subsequently added to address comorbid depressive symptoms, it failed to alleviate his respiratory distress. In contrast, the administration of clotiazepam (10 mg/day) resulted in rapid and marked improvement in both respiratory and peripheral dyskinetic movements within two days. Respiratory dyskinesia is a rare motor complication of Parkinson’s disease and Parkinsonism that severely impairs quality of life. Despite its clinical impact, no established standard therapy exists, and responses to conventional treatments, including dopaminergic adjustments and other pharmacological approaches, remain variable. In particular, the clinical efficacy of management with clotiazepam, a short-acting thienodiazepine, has not been previously documented in the literature. Our findings suggest that the anxiolytic and GABA-mediated muscle-relaxant properties of clotiazepam, combined with its favorable safety profile for the elderly due to its short half-life, may provide a useful and effective new therapeutic option for the management of refractory respiratory dyskinesia. Although the limitations of drawing conclusions from a single case must be acknowledged, these results warrant further large-scale prospective studies to validate the efficacy and safety of clotiazepam in this population.
Tsujimoto et al. (2026) studied this question.