title: Dementia with Lewy bodies presenting marked tongue protrusion and bite due to lingual dystonia: A case report.
abstract: We report the patient of a 53-year-old woman who developed subacute-onset marked tonge protrusion and bite. She was diagnosed as dementia with Lewy bodies (DLB) from the clinical features including progressive cognitive decline, visual hallucinations, parkinsonism, and severe insomnia and depression, and the radiological finding of low dopamine transported uptake in basal ganglia by Dat SCAN and low blood circulation in occipital lobe of cerebrum. The patient received 600 mg doses of levodopa for over a year, followed by rotigotine and ropinirole with a rapid increase of dosage. It is believed that these treatments stimulated and sensitized dopamine D1 receptors, thereby inducing lingual dystonia. Furthermore, the patient demonstrated dyspnea and attacks of apnea caused by the closure of bilateral vocal cords due to laryngeal dyskinesia. After initiation of the neuroleptic, olanzapine, for a short duration, the high dose of levodopa overlapped with neuroleptic sensitivity, suggesting DOPA-induced dystonia and dyskinesia. This interaction can sometimes lead to lethal adverse events, and must be considered very important when treating patients with DLB.
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shiga
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kanaya
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Kono
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takeshima
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shimoe
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuriyama
mesh_terms: D000208:Acute Disease; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D001733:Bites and Stings / Q000209:etiology*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000209:etiology*; D004421:Dystonia / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects; D007818:Laryngeal Diseases / Q000139:chemically induced*; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects*; D020961:Lewy Body Disease / Q000188:drug therapy*; D008875:Middle Aged; D000077152:Olanzapine; D017447:Receptors, Dopamine D1 / Q000378:metabolism; D013764:Tetrahydronaphthalenes / Q000008:administration & dosage / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects; D014060:Tongue Diseases / Q000139:chemically induced*
chemical_list: D014150:Antipsychotic Agents; D007211:Indoles; D017447:Receptors, Dopamine D1; D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C046649:ropinirole; D001569:Benzodiazepines; D007980:Levodopa; C047508:rotigotine; D000077152:Olanzapine