15 November 2021>: Articles
Unusual or unexpected effect of treatmentJonathan Doan A* , Irfan Sheikh A , Lawrence Elmer A , Mehmood Rashid A
Am J Case Rep 2021; 22:e933995
Video 2. Posttreatment with carbidopa-levodopa neurological examination.Finger-Nose and Past-Pointing Tests: • Patient undergoes repeat assessment of finger-nose and past-pointing tests after treatment with Sinemet 25-100 CR tablet for 3 days. • A continuation of dysmetria with significant overshoot with his dominant right hand is noticeable, but the ataxia component that was seen pretreatment is reduced. • In his nondominant hand (left), the patient continues to have ataxia when he attempts to reach out toward his target, with dysmetria and overshoot that are more pronounced when the patient transitions to the eye closure component of the examination. • Despite limited improvement in this assessment, the patient has marked improvement in the fluidity of his movements. Finger Tap Test: • After treatment with Sinemet, the patient has improved symmetry during the finger tap assessment. • There is also marked improvement in the amplitude of his finger tapping. Rapid Alternating Movement: • No significant improvement in the patient’s dysdiadochokinesia is noted after Sinemet treatment. He continues to have coarse and irregular movements with a remarkable double clap to triple clap with the palmar and dorsal aspect of his hand. • There is improvement in the speed of his inaccuracies, with less stuttering of movement. Heel-Knee Test: • There is no significant improvement in his ataxia after Sinemet treatment. There are still side-to-side oscillations of his heel when he slides his foot up his shin. Gait and Turn en Bloc Assessment: • After Sinemet treatment, significant improvement is seen in the patient’s gait. • A pronounced reduction is seen in his shuffling, with turn en bloc improving from 6 pivot steps to 2 pivot steps with his left foot.