Recovery after L-DOPA treatment in peginterferon and ribavirin induced parkinsonism.
BACKGROUND
Hepatitis C virus (HCV) chronically infects approximately 2% of the European population. Antiviral therapy with pegInterferon-alpha (PegIFN) and ribavirin (Rbv) is the standard of care, leading to HCV eradication in roughly 50% of patients. IFN-based therapy has been associated with high rates (20%) of central nervous system side effects, but only a few case reports exist on extrapyramidal side effects.


RESULTS
We report a 64-year-old man developing parkinsonism during PegIFN alfa-2a and ribavirin therapy for chronic hepatitis C. No improvement was observed after treatment discontinuation. Therefore, on the basis of previous clinical and experimental reports, levodopa-benserazide treatment was started. After substantial improvement, symptoms relapsed following drug tapering.


CONCLUSIONS
This is the first case of parkinsonism in a Caucasian patient receiving PegIFN/Rbv therapy. The rapid and significant improvement of symptoms obtained in our patient with levodopa-benserazide, suggests that this therapy could be considered as first line symptomatic treatment.
Department of Neurological Sciences Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, 7 IRCCS, Via F. Sforza 35, Università degli Studi di Milano, Milano, Italy. anna.bersano@unimi.it
A
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Bersano
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Aghemo
M G
MG
Rumi
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Ballabio
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Candelise
M
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Colombo
D000978:Antiparkinson Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects*; D001545:Benserazide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000188:drug therapy*; D011092:Polyethylene Glycols / Q000009:adverse effects*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects*
D000978:Antiparkinson Agents; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D007980:Levodopa; D012254:Ribavirin; D001545:Benserazide; C100416:peginterferon alfa-2a