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Chapter 14. Movement Disorders

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A 65-year-old man has had a diagnosis of tremor-predominant Parkinson disease for the last 4 years. He is on carbidopa/levodopa (25 mg/100 mg), taking one-and-a-half tablets four times a day, every 5 hours. The patient reports that 1 hour prior to the next dose of carbidopa/levodopa, he starts feeling stiffer with worsening of his tremors. Based on data from questionnaires correlating motor fluctuations with non-motor fluctuations, which of the following is the most frequent non-motor complication of carbidopa/levodopa in patients with Parkinson disease?

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(A) Anxiety

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(B) Pain

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(C) Numbness

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(D) Drooling

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(E) Sweating

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(A) The patient has motor fluctuations noted to be mainly predictably wearing off. In addition to motor fluctuations, patients with Parkinson disease have significant non-motor fluctuations. Non-motor fluctuations due to levodopa in PD patients are harder to measure. In questionnaires assessing the relation between motor and non-motor fluctuations, anxiety has been shown to be the most common non-motor symptom. (Aquino, 80–89)

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Aquino CC, Fox SH. Clinical spectrum of levodopa-induced complications. Mov Disord. 2015;30(1):80–89.

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A 75-year-old woman presents to your office for follow-up on tremor-predominant Parkinson disease. She has been on levodopa for the last 2 years with good effect. She has been attending support group meetings and has noticed multiple patients on levodopa with motor fluctuations. She wants to know if she has signs of motor fluctuations. For patients with Parkinson disease on levodopa, which of the following tends to be the earliest sign of motor fluctuations?

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(A) Sudden offs

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(B) Dose failure

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(C) End-of-dose rebound

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(D) Morning akinesia

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(E) On-off fluctuations

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(D) Motor fluctuations are almost inevitable in patients with Parkinson disease with no consistent pattern of presentation. Morning akinesia and predictable wearing off (wearing off at the end of the duration of effect of levodopa) are usually the earliest signs of motor fluctuations in PD patients on levodopa. All the other responses are categories of motor fluctuations, although they tend to occur with more advanced disease. (Aquino, 80–89)

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Aquino CC, Fox SH. Clinical spectrum of levodopa-induced complications. Mov Disord. 2015;30(1):80–89.

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A 75-year-old woman presents to your office for follow-up on tremor-predominant Parkinson disease. She has been on levodopa for the last 2 years with good effect. She has been attending support group meetings and has noticed multiple patients ...

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