Case ReportTransdermal dopaminergic stimulation with rotigotine in Parkinsonian akinetic crisis
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.
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Cited by (12)
Emergencies in parkinsonism: akinetic crisis, life-threatening dyskinesias, and polyneuropathy during L-Dopa gel treatment
2009, Parkinsonism and Related DisordersCitation Excerpt :The purpose of the present review is also in underlining incongruence and lack of evidence or knowledge. A literature review from 2005 to 2009 produced further case reports of Acute akinesia induced by prolonged constipation (deficit in absorption of medication) [15], acute anemia (caused by rectus sheath hematoma due to subcutaneous apomorphine administration) [16], pulmonary infection [28], and gastro-oesophageal ulcers [29], the first cases being treated with apomorphine and the last with rotigotine patch. Life-threatening dyskinesia does not exist in literature reports.
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