- Email: [email protected]
2.287 ROTIGOTINE-INDUCED NAIL DYSCHROMIA IN A PATIENT WITH PARKINSONS DISEASE
Tuesday, 13 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S81–S159
scores 20.7±10.2) on rotigotine treatment (mean dose: 3.8 mg/d), including binge eating, hypersexuality, compulsive shopping, pathological gambling, and punding, equaling a prevalence rate of 21%. Also in the the non-ICD group ZICD scores increased (7.5±2.8). Conclusion: This is the first report of ICD in patients treated with transdermal rotigotine for RLS. In contrast to literature, even low doses of rotigotine (mean 3.8 mg/d) can cause ICD. Therefore every prescribing physician should be aware that ICD may emerge in both RLS and PD patients on any dopaminergic treatment, and should actively ask for such symptoms. The ZICD questionnaire not only replicated the findings of detailed history taking but also showed an increased tendency towards impulsive behaviour in subjects that did not develop ICD.
S137
Methods: Case Report. Results: An 80-year-old man with a 15 year history of PD, experiencing complications of levodopa therapy (wearingoff phenomenon and peak-dose dyskinesias), was initiated on rotigotine patch (2 mg, titrated up to 6 mg/day). While this drug brought significant motor improvement, bilateral nail dyschromia with green nail (figure 1) discoloration was noticed within days after the change in therapeutic regimen. Two months after rotigotine withdrawal, ND completely disappeared (figure 2).
2.286 MIGRATORY EDEMA REALATED TO RASAGILINE TREATMENT M.J. Catalan, E. Lopez-Valdes, C. Villanueva, R. Garcia-Ramos. Neurology Department, Hospital Clinico San Carlos, Madrid, Spain Objective: Rasagiline, a selective MAO-B inhibitor, is usually well tolerated in Parkinson’s disease (PD). Few side effects have been reported in relation to its use. We present a patient with advanced PD, that develop a peripheral edema while he was in treatment with rasagilina. Materials: A 73 years old man with Parkinson disease of 7 years of evolution. He started on rasagiline and levodopa-carbidopa treatment and one year later he started with fluctuations. Levodopa daily doses were increased, and he needed levodopa in a 3 three hours schedule during the waking time. After 2 years he developed a left forearm swelling accompanied by itching and redness, following after few days, with extension to the hand and contralateral pretibial region. Pretibial and forearm oedema comes and goes and later resolved spontaneously. Hand oedema remained. Results: The patient was thoroughly studied with a complete analysis, vascular study and skin biopsy. No cause was found. Because the fluctuating response, nine months later the patient was changed to Jejunal duodopa infusion. At that point, rasagiline was stopped. Three days after stopped rasagiline the oedema resolved completely. Conclusion: We report a new secondary effect in relationship to rasagiline. MAO-A inhibitor drugs have been linked to peripheral oedema, but has not been related with the MAO-B inhibitor rasagiline. Oedema has been related with dopaminergic agonist, some times after a longer use, but usually symmetrical in both legs. Furthermore the localized and migratory asymmetric hand oedema is not usually a drug side effect. 2.287 ROTIGOTINE-INDUCED NAIL DYSCHROMIA IN A PATIENT WITH PARKINSONS DISEASE R.P. Munhoz, H.A.G. Teive. Federal University of Parana, Curitiba, Brazil Background: Rotigotine is the first non-ergot derived dopamine agonist administered via transdermal patch technology, indicated for use in early and advanced PD. The potential advantages of rotigotine include immediate effect onset, constant drug delivery, and ease of use, once-daily adhesive patch. Rotigotine demonstrated efficacy and safety as monotherapy in PD to reduce duration of OFF periods. Rotigotine has high affinity for dopamine D(2) and D(3) receptors. The most commonly reported adverse event are application-site reactions, somnolence and nausea. Druginduced nail abnormalities, particularly nail dyschromia, are wellknown complications related to several drugs, including zidovudine, cancer chemotherapies, retinoids, tetracycline and minocycline. The objective of this study is to present for the first time an unusual complication related to treatment of Parkinson’s disease (PD) with rotigotine transdermal patch.
Figure 1.
Figure 2. Conclusions: The close cause and effect relationship found in the case presented here demonstrates that rotigotine transdermal may be associated with nail dyschromia. Clinicians prescribing this drug should be aware of this reversible complication. 2.288 COMBINED ZOLPIDEM AND CARBIDOPA/LEVODOPA TREATMENT OF PROGRESSIVE SUPRANUCLEAR PALSY (PSP): A CASE REPORT WITH VIDEO DOCUMENTATION S. Chen1 , S. Juneja2 , S.L. Jaffe1 . 1 Neurology, 2 Medical School, Louisiana State University School of Medicine, Shreveport, LA, USA Introduction: PSP is characterized by ocular (supranuclear gaze palsies), motor (bradykinesia/akinesia, rigidity, postural impairment, extensor dystonia), and pseudobulbar (dysarthria, dysphagia) symptoms/signs in addition to frontal lobe/cognitive/personality impairment. Carbidopa/levodopa is the primary treatment medication although benefits are limited (striatal D2 receptor loss). In addition to dopaminergic and cholinergic circuitry, gabanergic circuitry is also affected in the PSP brain. A case of severe PSP was treated with zolpidem, a selective agonist of the benzodiazepine receptor (BZ1) on the GABA-A receptor complex, alpha subunit, and carbidopa/levodopa. Video documentation was obtained. Method: Case Report – A 63 year old man, end-stage/typical PSP, symptomatic for 4 years, with classical findings on brain MRI was treated with zolpidem IR, 5 mg, together with carbidopa/levodopa, 25/250, three times a day (7AM, Noon, and 5PM, i.e. q 5 hrs). Video documentation was obtained during baseline treatment with carbidopa/levodopa, and at 1 and 2 days after combination treatment. Results: Carbidopa/levodopa improved akinesia, limb rigidity, dysarthria and dysphagia. These benefits were augmented by adding zolpidem, and further immediate improvement (maximizing in 1 hour, lasting 5 hours) was observed in horizontal eye movement, facial expression, akinesia, limb and especially axial rigidity/extensor dystonia, resulting in the patient sitting, standing
scores 20.7±10.2) on rotigotine treatment (mean dose: 3.8 mg/d), including binge eating, hypersexuality, compulsive shopping, pathological gambling, and punding, equaling a prevalence rate of 21%. Also in the the non-ICD group ZICD scores increased (7.5±2.8). Conclusion: This is the first report of ICD in patients treated with transdermal rotigotine for RLS. In contrast to literature, even low doses of rotigotine (mean 3.8 mg/d) can cause ICD. Therefore every prescribing physician should be aware that ICD may emerge in both RLS and PD patients on any dopaminergic treatment, and should actively ask for such symptoms. The ZICD questionnaire not only replicated the findings of detailed history taking but also showed an increased tendency towards impulsive behaviour in subjects that did not develop ICD.
S137
Methods: Case Report. Results: An 80-year-old man with a 15 year history of PD, experiencing complications of levodopa therapy (wearingoff phenomenon and peak-dose dyskinesias), was initiated on rotigotine patch (2 mg, titrated up to 6 mg/day). While this drug brought significant motor improvement, bilateral nail dyschromia with green nail (figure 1) discoloration was noticed within days after the change in therapeutic regimen. Two months after rotigotine withdrawal, ND completely disappeared (figure 2).
2.286 MIGRATORY EDEMA REALATED TO RASAGILINE TREATMENT M.J. Catalan, E. Lopez-Valdes, C. Villanueva, R. Garcia-Ramos. Neurology Department, Hospital Clinico San Carlos, Madrid, Spain Objective: Rasagiline, a selective MAO-B inhibitor, is usually well tolerated in Parkinson’s disease (PD). Few side effects have been reported in relation to its use. We present a patient with advanced PD, that develop a peripheral edema while he was in treatment with rasagilina. Materials: A 73 years old man with Parkinson disease of 7 years of evolution. He started on rasagiline and levodopa-carbidopa treatment and one year later he started with fluctuations. Levodopa daily doses were increased, and he needed levodopa in a 3 three hours schedule during the waking time. After 2 years he developed a left forearm swelling accompanied by itching and redness, following after few days, with extension to the hand and contralateral pretibial region. Pretibial and forearm oedema comes and goes and later resolved spontaneously. Hand oedema remained. Results: The patient was thoroughly studied with a complete analysis, vascular study and skin biopsy. No cause was found. Because the fluctuating response, nine months later the patient was changed to Jejunal duodopa infusion. At that point, rasagiline was stopped. Three days after stopped rasagiline the oedema resolved completely. Conclusion: We report a new secondary effect in relationship to rasagiline. MAO-A inhibitor drugs have been linked to peripheral oedema, but has not been related with the MAO-B inhibitor rasagiline. Oedema has been related with dopaminergic agonist, some times after a longer use, but usually symmetrical in both legs. Furthermore the localized and migratory asymmetric hand oedema is not usually a drug side effect. 2.287 ROTIGOTINE-INDUCED NAIL DYSCHROMIA IN A PATIENT WITH PARKINSONS DISEASE R.P. Munhoz, H.A.G. Teive. Federal University of Parana, Curitiba, Brazil Background: Rotigotine is the first non-ergot derived dopamine agonist administered via transdermal patch technology, indicated for use in early and advanced PD. The potential advantages of rotigotine include immediate effect onset, constant drug delivery, and ease of use, once-daily adhesive patch. Rotigotine demonstrated efficacy and safety as monotherapy in PD to reduce duration of OFF periods. Rotigotine has high affinity for dopamine D(2) and D(3) receptors. The most commonly reported adverse event are application-site reactions, somnolence and nausea. Druginduced nail abnormalities, particularly nail dyschromia, are wellknown complications related to several drugs, including zidovudine, cancer chemotherapies, retinoids, tetracycline and minocycline. The objective of this study is to present for the first time an unusual complication related to treatment of Parkinson’s disease (PD) with rotigotine transdermal patch.
Figure 1.
Figure 2. Conclusions: The close cause and effect relationship found in the case presented here demonstrates that rotigotine transdermal may be associated with nail dyschromia. Clinicians prescribing this drug should be aware of this reversible complication. 2.288 COMBINED ZOLPIDEM AND CARBIDOPA/LEVODOPA TREATMENT OF PROGRESSIVE SUPRANUCLEAR PALSY (PSP): A CASE REPORT WITH VIDEO DOCUMENTATION S. Chen1 , S. Juneja2 , S.L. Jaffe1 . 1 Neurology, 2 Medical School, Louisiana State University School of Medicine, Shreveport, LA, USA Introduction: PSP is characterized by ocular (supranuclear gaze palsies), motor (bradykinesia/akinesia, rigidity, postural impairment, extensor dystonia), and pseudobulbar (dysarthria, dysphagia) symptoms/signs in addition to frontal lobe/cognitive/personality impairment. Carbidopa/levodopa is the primary treatment medication although benefits are limited (striatal D2 receptor loss). In addition to dopaminergic and cholinergic circuitry, gabanergic circuitry is also affected in the PSP brain. A case of severe PSP was treated with zolpidem, a selective agonist of the benzodiazepine receptor (BZ1) on the GABA-A receptor complex, alpha subunit, and carbidopa/levodopa. Video documentation was obtained. Method: Case Report – A 63 year old man, end-stage/typical PSP, symptomatic for 4 years, with classical findings on brain MRI was treated with zolpidem IR, 5 mg, together with carbidopa/levodopa, 25/250, three times a day (7AM, Noon, and 5PM, i.e. q 5 hrs). Video documentation was obtained during baseline treatment with carbidopa/levodopa, and at 1 and 2 days after combination treatment. Results: Carbidopa/levodopa improved akinesia, limb rigidity, dysarthria and dysphagia. These benefits were augmented by adding zolpidem, and further immediate improvement (maximizing in 1 hour, lasting 5 hours) was observed in horizontal eye movement, facial expression, akinesia, limb and especially axial rigidity/extensor dystonia, resulting in the patient sitting, standing