Treatment of Parkinson disease: a 64-year-old man with motor complications of advanced Parkinson disease.
In early stages, Parkinson disease typically begins with asymmetric or unilateral motor symptoms due to combinations of mild bradykinesia, rigidity, and tremor. In most cases, with progression, signs of more generalized bradykinesia appear, which include facial masking, reduced voice volume, and slowing of activities of daily living. In more advanced Parkinson disease, other disabling manifestations may follow, such as impaired balance, gait freezing, falls, speech disturbance, and cognitive impairment. Levodopa is the most effective medical treatment for Parkinson disease. However, motor complications uniquely related to levodopa treatment may emerge that may be difficult to manage. These include fluctuating levodopa responses and involuntary movements and postures known as dyskinesia and dystonia. Medication adjustments are usually effective, but in some cases surgical intervention with deep brain stimulation becomes necessary to alleviate motor complications. The case of Mr L, a man with an 11-year history of Parkinson disease, illustrates these emerging motor complications and the manner in which they may be managed both medically and surgically.
Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. dtarsy@bidmc.harvard.edu
Daniel
D
Tarsy
D000547:Amantadine / Q000008:administration & dosage; D000977:Antiparasitic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002230:Carbidopa / Q000008:administration & dosage / Q000009:adverse effects; D002396:Catechols / Q000008:administration & dosage / Q000009:adverse effects; D003657:Decision Making; D046690:Deep Brain Stimulation; D018450:Disease Progression; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy; D020233:Gait Disorders, Neurologic / Q000209:etiology; D005917:Globus Pallidus; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000008:administration & dosage / Q000009:adverse effects; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D011788:Quality of Life; D020530:Subthalamus
D000977:Antiparasitic Agents; D002396:Catechols; D009570:Nitriles; D007980:Levodopa; C071192:entacapone; D000547:Amantadine; D002230:Carbidopa