[Wearing off phenomenon presenting with features of paroxysmal abdominal pain].
Degenerative process in Parkinson's disease affects substantia nigra and other central structures of an extrapyramidal system but it can also affect central and peripheral autonomic centres. One of the most frequent late complications in levodopa therapy is a wearing off phenomenon. We present a patient treated for Parkinson's disease in whom during the period of levodopa wearing off we observed a paroxysmal abdominalgia apart from other features of a typical movement disorders like: increasing rigidity, gait disturbances and tremor. Abdominalgia consisted of stomach cramps, with variable localization in epi-, meso- and hypogastrium. Rectal tenesmus was also present. The patient was treated with analgesics, spasmolytics and carminative drugs with no effect. Abdominal pains regressed after an intake of the next levodopa dose. The patient presented with other features of a gastrointestinal tract autonomic system dysfunction like: chronic constipation, preterm satiety resulting in food intake reduction and a decrease in body weight. There was no organic lesions of the gastrointestinal system that could explain such disturbances. Pharmacologic treatment modification (more frequent levodopa dosage, additional dopamine agonist) resulted in some improvement.


CONCLUSIONS
It is possible that the abdominal pains could be a clinical manifestation of a digestive tract dyskinesias, occurring during
Kułakowska
Alina
A
Klinika Neurologii Akademii Medycznej w Białymstoku. alakul@amb.ac.bialystok.pl
Pogorzelski
Robert
R
Borowik
Helena
H
Drozdowski
Wiesław
W
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology; D019282:Wasting Syndrome / Q000209:etiology*; D015431:Weight Loss
D000978:Antiparkinson Agents; D007980:Levodopa