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Dyskinesias in an elderly patient: case report An elderly woman with Parkinson’s disease (PD) developed respiratory and limb/trunk dyskinesias during treatment with levodopa/carbidopa [age at onset, and duration of treatment to reaction onset not stated]. The woman was diagnosed with PD when she was 66 years old, and subsequently exhibited severe intolerance to levodopa, pramipexole, ropinirole and rotigotine patches [details not stated]; in general, drug dosages were limited by severe nausea. She began receiving carbidopa and levodopa/carbidopa, and was able to titrate the levodopa dosage to 100mg five times daily. If any dose was increased by 50–100mg, she developed severe peak-dose dyskinesia with dyspnoea and chest tightness due to respiratory dyskinesia. The woman’s levodopa/carbidopa dosage was decreased by 0.5 tablets per dose (each tablet contained levodopa/ carbidopa 100/25mg), and amantadine was added to her therapy. However, respiratory dyskinesia persisted unchanged, and limb dyskinesia only minimally improved. On presentation for evaluation of severe levodopa-induced breathing problems at the age of 72 years, she exhibited a short and shallow breathing pattern, hyperkinetic diaphragmatic movements and panting, in addition to PD symptoms. Respiratory dyskinesia symptoms occurred 1.5 to 2 hours after each levodopa/carbidopa dose, and she estimated that disabling dyskinesias were prevalent 40% of her waking time. Pulmonary function tests revealed an obstructive breathing pattern with a notching "saw tooth" pattern. A left globus pallidus interna deep brain stimulator (GPi-DBS) was implanted, followed by a pulse generator in her chest wall 30 days later. Her dyskinesias improved to lasting for 30–40 minutes after each dose during the first few weeks after GPi-DBS implantation. The pulse generator was activated 6 days after its implantation. Her medications were maintained unchanged. Dyskinesias immediately resolved and remained suppressed until follow-up 4 months later. At 12-month follow-up, dyskinesia suppression was maintained (< 25% a day); postoperative pulmonary function tests continued showing a mild obstructive breathing pattern, but no longer a "saw tooth" pattern. Oyama G, et al. Unilateral GPi-DBS as a treatment for levodopa-induced respiratory dyskinesia in parkinson disease. Neurologist 17: 282-285, No. 5, Sep 2011. Available from: URL: http://dx.doi.org/10.1097/nrl.0b013e318217367b 803062078 USA

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Reactions 29 Oct 2011 No. 1375