Citation

Moreira F, Rebelo Gomes I, Januário C. BMJ Case Rep. 2019; 12(7): e2019-229224.

Affiliation

Division of Movement Disorders, Department of Neurology, Coimbra Hospital and University Centre, Coimbra, Portugal.

Copyright

(Copyright © 2019, BMJ Publishing Group)

DOI

10.1136/bcr-2019-229224

PMID

31337633

Abstract

Freezing of gait (FOG) and postural instability are challenging motor symptoms that present a serious therapeutic dilemma in Parkinson's disease. Appropriate distinction between FOG subtypes may be difficult during routine clinical visits, as shown in the case we present. The patient was examined in three different states in relation to levodopa (L-DOPA) and apomorphine subcutaneous (sc) tests with video documentation: (1) 'overnight-off', after 12 hours without medication; (2)'on', 60 min after intake of regular levodopa dose (200 mg) and 20 min after 2 mg of apomorphine sc; and (3) 'supra-on', after 350 mg of L-DOPA and 3 mg of apomorphine sc. The patient clearly showed a dose-dependent paradoxical response to L-DOPA treatment with the emergence of severe FOG and postural instability. The tendency to develop these axial symptoms was less pronounced with apomorphine at doses that achieved similar improvements of other Parkinsonian features.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Language: en

Keywords

drugs: CNS (not Psychiatric); neurology; parkinson’s disease