Dropped head sign induced by transdermal application of the dopamine agonist rotigotine in parkinsonian syndrome: a case report.
Dropped head sign induced by transdermal application of the dopamine agonist rotigotine in parkinsonian syndrome: a case report.
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DOI：
10.1186/1752-1947-7-174
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发表时间：
2013-07-05
影响因子：
1
通讯作者：
Kermer, Pawel
中科院分区：
文献类型：
--
作者：
Dohm, Christoph P;Groschel, Sonja;Kermer, Pawel
引言：“头下垂征”与帕金森综合征中严重不成比例的前倾有关。我们提出的第一份报告罗替戈汀引起的下降头的迹象，在怀疑特发性帕金森氏病，后来被定义为多系统萎缩的患者。虽然在多系统萎缩中经常观察到不成比例的前倾，但在帕金森病中，“头下垂征”被认为是一种病因不明的罕见症状。它也被描述为卡麦角林和普拉克索多巴胺激动剂药物的副作用。罗替戈汀是一种经皮应用的非麦角类多巴胺激动剂，可持续刺激多巴胺受体，广泛用于治疗帕金森病患者。我们报告一例64岁的白人妇女与一个快速进展的2.5-一年的运动减退帕金森综合征病史，症状不对称发展，最初对左旋多巴药物反应良好。由于其他多巴胺药物的副作用，患者在临床入院前5周改用罗替戈汀药物。进行性前倾没有肌无力和突出的椎旁肌收缩在两周内治疗和解决后一周内停止罗替戈汀和左旋多巴/卡麦角林medication.CONCLUSION：虽然病理生理学仍然没有解决，这种情况下支持的概念，多巴胺能失衡的原因，某些轴向肌张力障碍，如不成比例的前倾，包括'头下降的迹象'。我们相信这个病例对神经科医生和全科医生特别有用，因为容易识别的症状应该促使对帕金森病患者的诊断和药物治疗进行彻底的重新评估。
INTRODUCTION: 'Dropped head sign' relates to a severe disproportionate antecollis in parkinsonism. We present the first report of a rotigotine-induced dropped head sign in a patient with suspected idiopathic Parkinson's disease, which was later defined as multiple system atrophy. The 'dropped head sign' is considered a rare symptom of unknown etiology in parkinsonian disorders, though a disproportionate antecollis is frequently observed in multiple system atrophy. It has also been described as a side effect of dopamine agonist medication with cabergoline and pramipexole. Rotigotine is a transdermally applied, non-ergot dopamine agonist, resulting in a continuous stimulation of dopamine receptors, which is widely used in the treatment of patients with Parkinson's disease.CASE PRESENTATION: We report a case of a 64-year-old Caucasian woman with a rapidly progressive two-and-a-half-year history of a hypokinetic Parkinson's syndrome with asymmetric development of symptoms and an initially good response to levodopa medication. Due to side effects of other dopamimetic medications the patient was switched to rotigotine medication five weeks before clinical admission. Progressive antecollis without muscle weakness and prominent paraspinal muscle contraction developed within two weeks of treatment and resolved within a week after discontinuation of rotigotine and initiation of levodopa/cabergoline medication.CONCLUSION: While the pathophysiology still remains unresolved, this case supports the concept of a dopaminergic imbalance as a cause of certain axial dystonias like disproportionate antecollis including the 'dropped head sign'. We believe this case is specifically useful for neurologists and general practitioners, as the easily recognizable symptom should prompt a thorough reevaluation of diagnosis and medication in patients with Parkinson's disease.