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I certainly appreciate the significance of Dr Gilden's criticism and, in fact, tried to anticipate it in my article. Therein it is indicated that the hemiballismus began three weeks before I first saw the patient in the hospital and had been progressively increasing in intensity and extent, so that at the time I did examine him, the hemiballismic excursions were pronounced and extremely incapacitating. Against this background of a worsening and flagrant involuntary movement disorder, the almost complete suppression of hemiballismus within 48 hours of starting haloperidol therapy strongly favors a therapeutic response to the drug.As noted by Dr Gilden, hemiballismus will often gradually improve, but never, I think, with the dramatic suddenness seen in my patient's presumed response to haloperidol. Indeed, the dosage of haloperidol was tapered away completely in six months without recurrence of hemiballismus.I also agree that it would be useful, once hemiballismus
Gilbert GJ. Response of Hemiballismus to Haloperidol-Reply. JAMA. 1976;235(5):475–476. doi:10.1001/jama.1976.03260310013006
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