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Unilateral Parkinson’s Disease and Contralateral Tardive Dyskinesia: A Unique Case with Successful Therapy That May Explain the Pathophysiology of These Two Disorders

  • S. Fahn
  • R. Mayeux
Part of the Journal of Neural Transmission book series (NEURAL SUPPL, volume 16)

Zusammenfassung

A unique case is reported of a patient with right-sided Parkinson’s disease and left-sided tardive dyskinesia. This Situation occurred because the patient’s parkinsonian tremor was treated with antipsychotic drugs. After several months she developed tardive dyskinesia on the left side of the body. Successful treatment was achieved nine years later, using dopaminedepleting drugs (combination reserpine and alpha-methylparatyrosine) to suppress the tardive dyskinesia and trihexyphenidyl to reduce the parkinsonism. Control of the symptoms was complicated when parkinsonism symptoms later increased on the right and developed on the left, due to the dopamine-depleting drugs. A small amount of carbidopa/levodopa restored the proper balance of symptoms, effectively reducing the parkinsonism while not aggravating the tardive dyskinesia.

This unique case provides insight into the pathogenesis of Parkinson’s disease, the pathogenesis of tardive dyskinesia, their successful therapeutic approaches, and possibly the effect of drugs in blocking the progression of Parkinson’s disease.

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References

  1. Birket-Smith, E.: Abnormal involuntary movements induced by anticholinergic medication. Acta Neurol. Scand. 50, 801–811 (1974).PubMedCrossRefGoogle Scholar
  2. Crane, G. E.: Tardive dyskinesia in patients treated with major neuroleptics: A review of the literature. Am. J. Psychiat. 124, suppl., 40–48 (1968).Google Scholar
  3. Fahrt, S.: Medical treatment of movement disorders. In: Neurological Reviews 1976, pp. 72–106. Minneapolis: American Academy of Neurology. 1976.Google Scholar
  4. Fahrt, S.: Akathisia in tardive dyskinesia. New Engl. J. Med. 299, 202 to 203 (1978 a).Google Scholar
  5. Fahrt, S.: Treatment of tardive dyskinesia with combined reserpine and alpha-methyltyrosine. Trans. Am. Neurol. Assoc. 103, 100–103 (1978 b).Google Scholar
  6. Fahrt, S., David, E.: Oral-facial-lingual dyskinesia due to anticholinergic medication. Trans. Am. Neurol. Assoc. 97, 277–279 (1972).Google Scholar
  7. Fahrt, S., Dujfy, P.: Parkinson’s disease. In: Scientific Approaches to Clinical Neurology (Goldensohn, E.S., Appel, S.H., eds.), pp. 1119–1158. Philadelphia: Lea and Febiger. 1977.Google Scholar
  8. Forrest, D. V., Fahn, S.: Tardive dysphrenia and subjective akathisia. J. Clin. Psychiat. 40, 206 (1979).Google Scholar
  9. Hornykiewicz, O.; Dopamine and extrapyramidal motor function and dysfunction. Res. Publ. Assoc. Res. Nerv. Ment. Dis. 50, 390–412 (1972).PubMedGoogle Scholar
  10. Hoehn, M. M., Yahr, M. D.: Parkinsonism: onset, progression, and mortality. Neurology 17, 427–442 (1967).PubMedGoogle Scholar
  11. Klawans, H. L.: The pharmacology of tardive dyskinesia. Am. J. Psychiat. 130, 82–86 (1973).PubMedGoogle Scholar
  12. Klawans, H. L., McKendall, R. R.: Observations on the effect of levodopa on tardive lingual-facial-buccal dyskinesia. J. Neurol. Sci. 14, 189–192 (1971).PubMedCrossRefGoogle Scholar
  13. Scott, R. M., Brody, J. A., Schwab, R. S., Cooper, J. S.: Progression of unilateral tremor and rigidity in Parkinson’s disease. Neurology 20, 710–714 (1970).PubMedGoogle Scholar
  14. Tarsy, D., Baldessarini, R. J.: The tardive dyskinesia Syndrome. Clin. Neuropharmacol. 1, 29–61 (1976).CrossRefGoogle Scholar
  15. Ungerstedt, U.: Mechanism of action of L-dopa studied in an experimental Parkinson model. In: Monoamines Noyaux Gris Centraux et Syndrome de Parkinson (de Ajuriaguerra, J., Gauthier, G., eds.), pp. 165–170 (Proceedings of the IVth Bei-Air Symposium). Geneva: Georg and Cie. 1971.Google Scholar

Copyright information

© Springer-Verlag 1980

Authors and Affiliations

  • S. Fahn
    • 1
    • 2
  • R. Mayeux
    • 1
  1. 1.Department of Neurology, College of Physicians and SurgeonsColumbia University, and The Neurological Institute of New YorkNew YorkUSA
  2. 2.Department of Neurology, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

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