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Motor fluctuation and dyskinesia: 4 case reports In a study, four patients including a man and a woman both aged 53 years (total 2 men and 2 women) were described, who developed motor fluctuation and dyskinesia during treatment with levodopa/carbidopa for Perry syndrome [not all dosages and time to reactions onsets stated; outcomes not stated]. The man aged 53 years (current presentation), initially developed symptoms of psychomotor slowing at the age of 42 years. Subsequently, treatment was started with oral levodopa/carbidopa along with unspecified dopamine agonist therapy with good motor response. The diagnosis of Perry syndrome was established at the age of 50 years. At the time of current presentation, response to levodopa/carbidopa was noted as preserved; however, development of levodopa/carbidopa-induced motor fluctuations and dyskinesia with a mixed pattern of chorea along with dystonia were noted. The woman aged 60 years, presented to clinic in 2016 with 12 months history of tremor that started in her left lower extremity and progressed to her right hand with subsequent slowness of movement. Other symptoms reported were severe insomnia, apathy, depression, anxiety and weight loss of 10kg in the previous 6 months. She was subsequently diagnosed with Perry syndrome. Three months prior to the presentation, her treatment was started with oral levodopa/carbidopa 125/12.5mg twice daily, but no improvement was noted. Family history included parkinsonism and respiratory failure in her two brothers, two sisters, mother and three maternal aunts. In the following two years, the dose of oral levodopa/carbidopa was progressively increased to 250mg/25mg three times daily with good control of her PS symptoms; however, she started to develop levodopa/carbidopa therapy related motor fluctuations and mild to moderate levodopa/carbidopa-induced dyskinesia. Despite the development of levodopa/carbidopainduced dyskinesia, her dosing frequency was increased to every 4 hours due to worsening Perry syndrome. The man aged 58 years, presented to a clinic in 2015 with 6 months history of rest tremor in his right hand along with slowness. He was subsequently diagnosed with Perry syndrome, and his treatment was started with oral levodopa/carbidopa at a total daily dose of 250/25mg divided into two doses with a good response. Over the following two years, his levodopa/carbidopa dose was progressively increased due to worsening symptoms of Perry syndrome despite the development of mild motor fluctuations related to the levodopa/carbidopa therapy. Three years after disease onset, his levodopa/carbidopa therapy was continued at a total daily dose of 750/75 mg in three divided doses with a good control. The woman with symmetrical upper limb tremor and poor balance issues (the symptoms started at the age of 47 years), was diagnosed with Perry Syndrome. Her concurrent conditions included hypothyroidism (under treatment with levothyroxine sodium). Subsequently, her treatment was started with oral levodopa/carbidopa, which showed a good r