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Olfactory Disturbance in Parkinson Disease

Olfactory Disturbance in Parkinson Disease We read with interest the article by Landis and Burkhard titled “Phantosmias and Parkinson Disease.”1 We describe a 70-year-old man who initially developed infrequent bowel movements and constipation more than 3 years ago followed by symptoms consistent with rapid eye movement sleep behavior disorder and olfactory hallucinations for about 2.5 years. The phantosmias were constant initially but became intermittent after the onset of motor symptoms. The patient describes these as stinky and unpleasant. They have kept him home because he perceives them as body odor. There is no associated loss of awareness, confusion, automatisms, convulsive seizures, or visual or auditory hallucinations. He has no history of head injuries. Others are unable to smell these odors. His sense of smell is not as good as before, but his ability to taste is intact. Electroencephalography performed in June 2007 showed left temporal slow waves with intermixed sharp waves. Trials of levetiracetam slowly titrated to 750 mg twice daily and 10 mg of aripiprazole at bedtime failed to change these perceptions. Results of a repeat electroencephalogram when the patient was not receiving levetiracetam were normal. A left supination-pronation tremor, most prominent at rest, began about 2 years ago and responded to 25 mg of carbidopa and 100 mg of levodopa three times a day. Progressive cognitive problems with prominent difficulties in attention, multitasking, and visuospatial abilities developed over a few years. This patient had phantosmias and other premotor symptoms developing temporally in accordance with the staging system of Braak.2,3 Our patient differed from the 2 patients described by Landis and Burkhard in that in our patient the olfactory hallucinations were unpleasant and initially constant, diminishing in frequency but not disappearing with the onset of motor symptoms. With early cognitive changes, there is a question of diffuse Lewy body disease in our patient, but there were no hallucinations in the visual or auditory spheres. Interestingly, he had phantosmias for at least 7 months before mentioning them to his physicians. We agree that olfactory hallucinations may be a more frequent premotor symptom of Lewy body involvement of the olfactory bulbs and anterior olfactory nucleus than previously noted. Prospective studies should be done to look for phantosmias in conjunction with other premotor symptoms in patients with idiopathic Parkinson disease. Correspondence: Dr Schwankhaus, Department of Neurology, Central Arkansas VA Hospital and University of Arkansas for Health Sciences, 4300 W 7th St, Little Rock, AR 72205 (john.schwankhaus@med.va.gov). Financial Disclosure: None reported. References 1. Landis BNBurkhard PR Phantosmias and Parkinson disease. Arch Neurol 2008;65 (9) 1237- 1239PubMedGoogle ScholarCrossref 2. Braak HDel Tredici KRüb Ude Vos RAJansen Steur ENBraak E Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging 2003;24 (2) 197- 211PubMedGoogle ScholarCrossref 3. Wolters EChBraak H Parkinson's disease: premotor clinico-pathological correlations. J Neural Transm Suppl 2006; (70) 309- 319PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Olfactory Disturbance in Parkinson Disease

Archives of Neurology , Volume 66 (6) – Jun 1, 2009

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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneurol.2009.87
Publisher site
See Article on Publisher Site

Abstract

We read with interest the article by Landis and Burkhard titled “Phantosmias and Parkinson Disease.”1 We describe a 70-year-old man who initially developed infrequent bowel movements and constipation more than 3 years ago followed by symptoms consistent with rapid eye movement sleep behavior disorder and olfactory hallucinations for about 2.5 years. The phantosmias were constant initially but became intermittent after the onset of motor symptoms. The patient describes these as stinky and unpleasant. They have kept him home because he perceives them as body odor. There is no associated loss of awareness, confusion, automatisms, convulsive seizures, or visual or auditory hallucinations. He has no history of head injuries. Others are unable to smell these odors. His sense of smell is not as good as before, but his ability to taste is intact. Electroencephalography performed in June 2007 showed left temporal slow waves with intermixed sharp waves. Trials of levetiracetam slowly titrated to 750 mg twice daily and 10 mg of aripiprazole at bedtime failed to change these perceptions. Results of a repeat electroencephalogram when the patient was not receiving levetiracetam were normal. A left supination-pronation tremor, most prominent at rest, began about 2 years ago and responded to 25 mg of carbidopa and 100 mg of levodopa three times a day. Progressive cognitive problems with prominent difficulties in attention, multitasking, and visuospatial abilities developed over a few years. This patient had phantosmias and other premotor symptoms developing temporally in accordance with the staging system of Braak.2,3 Our patient differed from the 2 patients described by Landis and Burkhard in that in our patient the olfactory hallucinations were unpleasant and initially constant, diminishing in frequency but not disappearing with the onset of motor symptoms. With early cognitive changes, there is a question of diffuse Lewy body disease in our patient, but there were no hallucinations in the visual or auditory spheres. Interestingly, he had phantosmias for at least 7 months before mentioning them to his physicians. We agree that olfactory hallucinations may be a more frequent premotor symptom of Lewy body involvement of the olfactory bulbs and anterior olfactory nucleus than previously noted. Prospective studies should be done to look for phantosmias in conjunction with other premotor symptoms in patients with idiopathic Parkinson disease. Correspondence: Dr Schwankhaus, Department of Neurology, Central Arkansas VA Hospital and University of Arkansas for Health Sciences, 4300 W 7th St, Little Rock, AR 72205 (john.schwankhaus@med.va.gov). Financial Disclosure: None reported. References 1. Landis BNBurkhard PR Phantosmias and Parkinson disease. Arch Neurol 2008;65 (9) 1237- 1239PubMedGoogle ScholarCrossref 2. Braak HDel Tredici KRüb Ude Vos RAJansen Steur ENBraak E Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging 2003;24 (2) 197- 211PubMedGoogle ScholarCrossref 3. Wolters EChBraak H Parkinson's disease: premotor clinico-pathological correlations. J Neural Transm Suppl 2006; (70) 309- 319PubMedGoogle Scholar

Journal

Archives of NeurologyAmerican Medical Association

Published: Jun 1, 2009

Keywords: parkinson disease,smell perception

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