Case Report
Transdermal dopaminergic stimulation with rotigotine in Parkinsonian akinetic crisis

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Abstract

Akinetic crisis (AC) is a much-feared complication of Parkinson’s disease (PD) which may appear upon abrupt cessation or malabsorption of dopaminergic medication due to gastrointestinal tract disorders or acute surgery. Intravenous infusion of amantadine sulphate or subcutaneous administration of apomorphine are established treatment strategies for AC. We speculate whether the use of a non-invasive transdermal application form (patch) of a dopaminergic drug (rotigotine) may represent a useful alternative treatment option. We describe the successful treatment of severe AC using rotigotine in a PD patient with gastro-oesophageal ulcers which precluded administration of any oral medication. This case demonstrates that a rotigotine patch might be effective in the treatment of AC. We suggest that rotigotine may represent a useful treatment option due to its favourable receptor profile and unique application form. In particular, it may be helpful in situations that might provoke AC, such as acute surgery. However, experience of the use of the rotigotine patch in this clinical setting is rather sparse and the patch is currently not approved for this indication.

Introduction

Akinetic crisis (AC) is a serious complication of Parkinson’s disease (PD) and may appear following the abrupt cessation or malabsorption of dopaminergic medication.1, 2 The poor absorption of dopaminergic medication may be associated with adverse conditions such as infectious disease, gastrointestinal tract disorders or surgery. The oral administration of standard anti-PD drugs is often complicated by concomitant dysphagia and gastroparesis. Intravenous administration of amantadine sulphate or subcutaneous doses of apomorphine are therefore commonly used to treat AC. This study demonstrates the usefulness of transdermally administered rotigotine (a new non-ergolinic dopamine agonist) as an alternative treatment option for PD patients suffering from AC.

Section snippets

Case report

A 64-year-old non-demented male patient, with a 9-year history of levodopa-responsive PD, suffered subacute odynophagia caused by multiple severe oesophageal fissures and ulcers. As a result, a phase of continuous rigidity and hypokinesia developed which lasted for three days. On admission, the bed-ridden patient was dehydrated and nearly akinetic and unable to follow instructions adequately (Unified Parkinson’s Disease Rating Scale [UPDRS] motor score3 84 points). Blood tests showed an

Discussion

The intravenous infusion of amantadine sulphate and the subcutaneous administration of apomorphine are two well-established treatment strategies for PD patients suffering from AC.4, 5 However, the use of amantadine should be limited in patients with renal failure and the administration of apomorphine to anaemic patients may be problematic due to the potential risk of haemolysis.6, 7 Moreover, neither strategy is always capable of reversing AC within a short period of time. A slow rate of

Acknowledgments

We thank Paul Reid and Gary Brook for help with the English version of the manuscript.

References (15)

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