Levodopa
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Peak dose dyskinesias: case report An elderly woman [exact age not stated] developed peak dose dyskinesias during treatment with levodopa for Parkinson’s disease. The woman, who had a history of total four herpes zoster infections between 8 and 17 years prior, had developed a post-herpetic neuralgia. Her past treatment for post-herpetic neuralgia included gabapentin, amitriptyline, pregabalin, oxycodone and hydromorphone, which was ineffective. Thereafter, she was diagnosed with Parkinson’s disease, and had been receiving levodopa [route and initial dosage not stated] and amantadine. During the treatment, she developed levodopa-induced peak dose dyskinesias, which were present for approximately 30% of the day. She also had debilitation motor fluctuations. She scored 87 on the Unified Dyskinesia Rating scale. Her levodopa equivalent dose was 850 mg/day at that time. As the increase in levodopa dose might led to dyskinesias, she was referred for further management of Parkinson’s disease and post-herpetic neuralgia at the age of 80 years (nine years after the diagnosis of Parkinson’s disease). Due to skull density, hyperostosis and her clinical condition, radiofrequency rightsided pallidotomy was planned. Subsequently, she underwent pallidotomy and her imaging showed proper anatomical lesion placement. Two months after the operation, frequency and intensity of the dyskinesias had reduced. She scored 15 on the Unified Dyskinesia Rating scale. Subsequently, the dose of levodopa was increased and amantadine was discontinued. Sixteen months after the operation, a significant improvement in her Parkinson’s disease was noted without recurrence of dyskinesias. Her post-herpetic neuralgia had also resolved. de Vloo P, et al. Complete resolution of postherpetic neuralgia following pallidotomy: Case report. Journal of Neurosurgery 133: 1229-1234, No. 4, Oct 2020. Available from: 803517772 URL: http://doi.org/10.3171/2019.7.JNS191050
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Reactions 28 Nov 2020 No. 1832
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