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Here, I report the case of a 70-year-old man with dementia with Lewy bodies (DLB) who experienced an improvement in Parkinsonism with zonisamide treatment without worsening of visual hallucinations or induction of orthostatic hypotension. The patient was initially medicated with levodopa, ropinirole and donepezil to treat Parkinsonism and dementia, as well as visual hallucinations. Selegiline was later added to help manage a subsequent aggravation of his Parkinsonism. Under this treatment regimen, motor symptoms improved, but adverse effects such as visual hallucinations, orthostatic hypotension and syncopal attacks appeared. Therefore, selegiline was replaced with zonisamide at a dose of 25 mg per day. Subsequently, the visual hallucinations and orthostatic hypotension rapidly improved and, 3 months later, the severity of his short steppage gait was alleviated. This case report describes a patient with DLB who experienced improvement in motor symptoms by incorporating zonisamide into the treatment regimen without deterioration of visual hallucinations or orthostatic hypotension. If adverse effects such as visual hallucinations and orthostatic hypotension are seen in patients with DLB following the use of dopamine agents, zonisamide might be a good alternative therapeutic option. Proper clinical trials need to be done to validate a therapeutic potential of zonisamide in DLB..

Improvement in Parkinsonism with Zonisamide Treatment in a Patient with Dementia with Lewy Bodies