title: Apraxia of lid opening: dose-dependent response to carbidopa-levodopa.
abstract: A 67-year-old woman with an 8-year history of Parkinson's disease and Lewy body dementia experienced difficulty in opening her eyelids (apraxia of lid opening [ALO]); she could close them without difficulty. This problem emerged 2 weeks after the patient's dosage of carbidopa 50 mg-levodopa 200 mg 3 times/day was decreased to twice/day. Two weeks after the onset of ALO the patient visited her physician, who suspected carbidopa-levodopa of causing the problem; the drug was discontinued. When the patient's condition worsened rather than improved, she was referred to a neuro-ophthalmologist, who confirmed the diagnosis of ALO. However, the neuro-ophthalmologist noted that this may not have been a true apraxia but rather a form of sustained blepharospasm that prevented the eyelid from opening. Carbidopa-levodopa was restarted, and her condition improved dramatically when her dosage was increased gradually to carbidopa 50 mg-levodopa 200 mg in the morning and at noon, and carbidopa 25 mg-levodopa 100 mg in the evening. Clinicians should be aware of adverse reactions, such as AOL, in patients taking carbidopa-levodopa who have dementia of the Lewy body type.
authors.affiliation: School of Pharmacy, Loma Linda University, Loma Linda, California, USA.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Lee
authors.forename: Ron
authors.initials: R
authors.lastname: Finley
authors.forename: Bruce
authors.initials: B
authors.lastname: Miller
mesh_terms: D000368:Aged; D020240:Apraxia, Ideomotor / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D001764:Blepharospasm / Q000150:complications / Q000517:prevention & control; D002230:Carbidopa / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005141:Eyelid Diseases / Q000139:chemically induced*; D005143:Eyelids / Q000187:drug effects / Q000294:innervation* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D020961:Lewy Body Disease / Q000150:complications / Q000175:diagnosis; D013997:Time Factors
chemical_list: D004338:Drug Combinations; D007980:Levodopa; D002230:Carbidopa