Helping the Battle of Iron Man

This is a 45 year old male who was seen for consult last May 28, 2017. His history started in January of 2005 as pulling of the neck that soon after progressed to include pulling of the jaw. It was in the same year that there was note of twisting of the body. In 2012 there was also note of leg posturing. Speech impairment came later in 2015. Patient’s maternal ancestry came from Iloilo, though he now resides in Davao. He has uncle and cousins with dystonia. Recently his wife noted significant weight loss from 74 kg to 40 kg in a matter of a year. He worked as a high school teacher, in Matina, Davao. He is married with 2 children. He is non smoker and non alcoholic beverage drinker. There were no exposure to pesticides or herbicides. On examination he was seen to have flexed trunk posture, the mouth is slightly opened with increased salivation. Noted dystonic posturing of the right arm and right leg more notable when he walks. Speech is moderately impaired. He has hypomimia and has decreased arm swing on either side. This is a clinically definite X-linked Dystonia Parkinsonism in the presence of the dystonic and parkinsonian features, strong family history and maternal family hailing from the Panay islands. He is on Biperiden and Clonazepan as maintenance medications. Mr. Bangkas can be a candidate for implantation of Neurostimulator - deep brain stimulation. Je will go through screening procedures for this.