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Apraxia of Lid Opening: Dose‐Dependent Response to Carbidopa‐Levodopa
Author(s) -
Lee Kelly C.,
Finley Ron,
Miller Bruce
Publication year - 2004
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.24.4.401.33174
Subject(s) - carbidopa , apraxia , levodopa , medicine , morning , dementia , benserazide , psychology , anesthesia , parkinson's disease , surgery , disease , psychiatry , aphasia
A 67‐year‐old woman with an 8‐year history of Parkinson's disease and Lewy body dementia experienced difficulty in opening her eyelids (apraxia of lid opening [ALO]); she could close them without difficulty. This problem emerged 2 weeks after the patient's dosage of carbidopa 50 mg–levodopa 200 mg 3 times/day was decreased to twice/day. Two weeks after the onset of ALO the patient visited her physician, who suspected carbidopa‐levodopa of causing the problem; the drug was discontinued. When the patient's condition worsened rather than improved, she was referred to a neuroophthalmologist, who confirmed the diagnosis of ALO. However, the neuroophthalmologist noted that this may not have been a true apraxia but rather a form of sustained blepharospasm that prevented the eyelid from opening. Carbidopa‐levodopa was restarted, and her condition improved dramatically when her dosage was increased gradually to carbidopa 50 mg–levodopa 200 mg in the morning and at noon, and carbidopa 25 mg–levodopa 100 mg in the evening. Clinicians should be aware of adverse reactions, such as AOL, in patients taking carbidopa‐levodopa who have dementia of the Lewy body type.