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Permanent Dementia in Idiopathic Parkinsonism Treated With Levodopa

Permanent Dementia in Idiopathic Parkinsonism Treated With Levodopa Abstract An acute confusional-hallucinatory syndrome, followed by stupor and permanent dementia occurred in a patient with mild idopathic parkinsonism receiving trihexy-phenidyl, amantadine, and levodopa. During the stuporous period, his eyes were divergent, with absent oculocephalic reflexes. There were no abnormalities of other cranial nerve functions or long tract signs. Intravenous doses of pyridoxine were of no benefit. The electroencephalogram was diffusely slow. Results of laboratory studies were unremarkable, except for mild hydrocephalus ex vacuo. Seventeen days after onset, he began to recover from stupor, and became alert but profoundly demented until his death four months later. Neuropathological changes included depigmentation, neuronal loss, gliosis and Lewy bodies in the substantia nigra, mild hydrocephalus, mild atherosclerotic changes in basilar and carotid arteries, and a few tiny cerebellar infarcts. Pathological changes did not explain the acute illness. References 1. Barbeau A, Mars H, Gillo-Joffroy L: Adverse clinical side effects of levodopa therapy , in McDowell F, Markham CH (eds): Recent Advances in Parkinson's Disease . Contemporary Neurology Series, Philadelphia, FA Davis Co, 1971, chap 8. 2. Goodwin FK: Psychiatric side effects of levodopa in man . JAMA 218:1915-1920, 1971.Crossref 3. Levodopa for parkinsonism , editorial. Br Med J 1:244-245, 1971.Crossref 4. Barbeau A: L DOPA therapy in Parkinson's disease: A critical review of nine years experience . Can Med Assoc J 101:59-68, 1969. 5. Bunney W: Present status of psychological reactions to L DOPA . Am J Psychiatry 127:361-362, 1970. 6. Celesia GG, Barr AN: Psychosis and other psychiatric manifestations of levodopa therapy . Arch Neurol 23:193-200, 1970.Crossref 7. Clark W: Some aspects of the pharmacology of the psychic and behavioral effects of L DOPA , in Barbeau A, McDowell F (eds): L Dopa and Parkinsonism . Philadelphia, FA Davis Co, 1970, chap 11. 8. Riklan M: Levodopa and behavior . Neurology 22( (suppl) ):43-55, 1972.Crossref 9. McDowell F, et al: The clinical use of levo-dopa in the treatment of Parkinson's disease , in Markham CH, McDowell F (eds): Contemporary Neurology Series No. 8 . Philadelphia, FA Davis Co, 1971, chap 7. 10. Loranger AW, et al: Levodopa treatment of Parkinson's syndrome . Arch Gen Psychiatry 26:163-168, 1972.Crossref 11. Sacks O, et al: Effects of L DOPA in patients with dementia . Lancet 1:1231, 1970.Crossref 12. Ansel R, Markham C: Effects of L DOPA in normal humans , in Barbeau A, McDowell F (eds): L DOPA and Parkinsonism . Philadelphia, FA Davis Co, 1970, chap 3. 13. Weinmann RL: Levodopa and hallucination . JAMA 221:1054, 1972.Crossref 14. Barbeau A: L DOPA and abnormal methylation , in Barbeau A, McDowell F (eds): L DOPA and Parkinsonism . Philadelphia, FA Davis Co, 1970, chap 11. 15. Wurtman R: Effects of levodopa on nondopaminergic brain neurons . Neurology 22( (suppl) ): 72-81, 1972.Crossref 16. Sacks OW, Messeloff DR, Schwartz WF: Long-term effects of levodopa in the severely disabled patient . JAMA 213:2270, 1970.Crossref 17. Sacks OW, Kohl M: Incontinent nostalgia induced by L DOPA . Lancet 1:1394, 1970.Crossref 18. Sacks OW, et al: Effects of levodopa in parkinsonian patients with dementia . Neurology 22:516-519, 1972.Crossref 19. McDowell F, Lee JE: LETTER TO THE EDITOR . JAMA 214:2059, 1970.Crossref 20. Mones RJ: LETTER TO THE EDITOR . JAMA 214:2059-2060, 1970.Crossref 21. Ryan RL: Levodopa . JAMA 214:2059, 1970.Crossref 22. Anden N, et al: Oral L-dopa treatment of parkinsonism . Acta Med Scand 187:247-255, 1970.Crossref 23. Lehmann J: Levodopa and depression in parkinsonism . Lancet 1:140, 1971.Crossref 24. Barbeau A: Long term side effects of levodopa . Lancet 1:395, 1971.Crossref 25. Barbeau A: Long term appraisal of levodopa therapy . Neurology 22( (suppl) ):22-24, 1972.Crossref 26. McDowell F: Discussion on long term safety and efficacy of levodopa . Neurology 22( (suppl) ): 24-37, 1972. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Permanent Dementia in Idiopathic Parkinsonism Treated With Levodopa

Wolf, Sheldon M.; Davis, Richard L.
Archives of Neurology , Volume 29 (4) – Oct 1, 1973
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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1973 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1973.00490280088014
Publisher site
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Abstract

Abstract An acute confusional-hallucinatory syndrome, followed by stupor and permanent dementia occurred in a patient with mild idopathic parkinsonism receiving trihexy-phenidyl, amantadine, and levodopa. During the stuporous period, his eyes were divergent, with absent oculocephalic reflexes. There were no abnormalities of other cranial nerve functions or long tract signs. Intravenous doses of pyridoxine were of no benefit. The electroencephalogram was diffusely slow. Results of laboratory studies were unremarkable, except for mild hydrocephalus ex vacuo. Seventeen days after onset, he began to recover from stupor, and became alert but profoundly demented until his death four months later. Neuropathological changes included depigmentation, neuronal loss, gliosis and Lewy bodies in the substantia nigra, mild hydrocephalus, mild atherosclerotic changes in basilar and carotid arteries, and a few tiny cerebellar infarcts. Pathological changes did not explain the acute illness. References 1. Barbeau A, Mars H, Gillo-Joffroy L: Adverse clinical side effects of levodopa therapy , in McDowell F, Markham CH (eds): Recent Advances in Parkinson's Disease . Contemporary Neurology Series, Philadelphia, FA Davis Co, 1971, chap 8. 2. Goodwin FK: Psychiatric side effects of levodopa in man . JAMA 218:1915-1920, 1971.Crossref 3. Levodopa for parkinsonism , editorial. Br Med J 1:244-245, 1971.Crossref 4. Barbeau A: L DOPA therapy in Parkinson's disease: A critical review of nine years experience . Can Med Assoc J 101:59-68, 1969. 5. Bunney W: Present status of psychological reactions to L DOPA . Am J Psychiatry 127:361-362, 1970. 6. Celesia GG, Barr AN: Psychosis and other psychiatric manifestations of levodopa therapy . Arch Neurol 23:193-200, 1970.Crossref 7. Clark W: Some aspects of the pharmacology of the psychic and behavioral effects of L DOPA , in Barbeau A, McDowell F (eds): L Dopa and Parkinsonism . Philadelphia, FA Davis Co, 1970, chap 11. 8. Riklan M: Levodopa and behavior . Neurology 22( (suppl) ):43-55, 1972.Crossref 9. McDowell F, et al: The clinical use of levo-dopa in the treatment of Parkinson's disease , in Markham CH, McDowell F (eds): Contemporary Neurology Series No. 8 . Philadelphia, FA Davis Co, 1971, chap 7. 10. Loranger AW, et al: Levodopa treatment of Parkinson's syndrome . Arch Gen Psychiatry 26:163-168, 1972.Crossref 11. Sacks O, et al: Effects of L DOPA in patients with dementia . Lancet 1:1231, 1970.Crossref 12. Ansel R, Markham C: Effects of L DOPA in normal humans , in Barbeau A, McDowell F (eds): L DOPA and Parkinsonism . Philadelphia, FA Davis Co, 1970, chap 3. 13. Weinmann RL: Levodopa and hallucination . JAMA 221:1054, 1972.Crossref 14. Barbeau A: L DOPA and abnormal methylation , in Barbeau A, McDowell F (eds): L DOPA and Parkinsonism . Philadelphia, FA Davis Co, 1970, chap 11. 15. Wurtman R: Effects of levodopa on nondopaminergic brain neurons . Neurology 22( (suppl) ): 72-81, 1972.Crossref 16. Sacks OW, Messeloff DR, Schwartz WF: Long-term effects of levodopa in the severely disabled patient . JAMA 213:2270, 1970.Crossref 17. Sacks OW, Kohl M: Incontinent nostalgia induced by L DOPA . Lancet 1:1394, 1970.Crossref 18. Sacks OW, et al: Effects of levodopa in parkinsonian patients with dementia . Neurology 22:516-519, 1972.Crossref 19. McDowell F, Lee JE: LETTER TO THE EDITOR . JAMA 214:2059, 1970.Crossref 20. Mones RJ: LETTER TO THE EDITOR . JAMA 214:2059-2060, 1970.Crossref 21. Ryan RL: Levodopa . JAMA 214:2059, 1970.Crossref 22. Anden N, et al: Oral L-dopa treatment of parkinsonism . Acta Med Scand 187:247-255, 1970.Crossref 23. Lehmann J: Levodopa and depression in parkinsonism . Lancet 1:140, 1971.Crossref 24. Barbeau A: Long term side effects of levodopa . Lancet 1:395, 1971.Crossref 25. Barbeau A: Long term appraisal of levodopa therapy . Neurology 22( (suppl) ):22-24, 1972.Crossref 26. McDowell F: Discussion on long term safety and efficacy of levodopa . Neurology 22( (suppl) ): 24-37, 1972.

Journal

Archives of Neurology – American Medical Association

Published: Oct 1, 1973

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