Anticholinergic drugs: response of parkinsonism not responsive to levodopa.
A 41 year old man with parkinsonism and pyramidal signs is described. He was non-responsive to levodopa and dopamine receptor agonists but dramatically responded to trihexyphenidyl. In this patient, brain MRI showed bilateral hyperintensities along the corticospinal tracts on T2 weighted images. PET studies showed a decrease in (18)F-6-fluorodopa uptake in the putamen contralateral to the more affected limbs and normal D(2) receptor binding in the putamen. The PET and MRI findings and responsiveness to antiparkinsonian agents suggested degeneration of nigrostriatal dopaminergic neurons, striatal output pathways, and corticospinal tracts.
Yamada
H
H
Department of Neurology, Yokohama City University, Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. hito1016@urahp.yokohama-cu.ac.jp
Momose
T
T
Okada
M
M
Kuroiwa
Y
Y
D000328:Adult; D001931:Brain Mapping; D018680:Cholinergic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D003342:Corpus Striatum / Q000187:drug effects / Q000473:pathology; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D009474:Neurons / Q000187:drug effects / Q000473:pathology; D020734:Parkinsonian Disorders / Q000175:diagnosis / Q000188:drug therapy*; D011712:Pyramidal Tracts / Q000187:drug effects / Q000473:pathology; D013378:Substantia Nigra / Q000187:drug effects / Q000473:pathology; D014055:Tomography, Emission-Computed; D014282:Trihexyphenidyl / Q000008:administration & dosage* / Q000009:adverse effects
D018680:Cholinergic Antagonists; D007980:Levodopa; D014282:Trihexyphenidyl