Pramipexole-induced antecollis in Parkinson's disease
ABSTRACT We report a case of antecollis, or dropped head with Parkinson's disease (PD) induced by pramipexole, a nonergot dopamine agonist. An 80-year-old woman presented with progressively severe neck flexion, which developed within a few weeks of taking pramipexole at 3 mg/day. She had a disturbed gait and complained of difficulty in daily activity because of restricted visual field and severe stooped posture. Surface EMG showed disproportionate tonus of the neck muscles but needle EMG of the neck muscles was normal. Withdrawal of pramipexole resulted in immediate improvement; the patient could keep the head in natural position and walk normally. Pramipexole-induced antecollis may be serious, but is a reversible dystonia in patients with PD. Clinicians should be aware of such complication.
- SourceAvailable from: Hideyuki Sawada
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- "AP is thought to be an extrapyramidal sign because it can appear in untreated patients, as described in the historic paper by James Parkinson , and many clinical factors regarding severity of PD have been identified as risk factors for camptocormia , , , . However, recent case reports indicate the association of dopaminergic replacement therapy, especially by dopamine agonists, and anterocollis , , , , ,  or Pisa syndrome , , , , suggesting a drug-related phenomenon. Camptocormia is thought to be caused by muscular rigidity ,  or axial dystonia , , , at least in the early stages of PD. "
ABSTRACT: Abnormal posture (AP) is often seen in Parkinson's disease (PD), and marked forms known as dropped head syndrome and camptocormia encumber daily living activities. Unlike other motor disabilities such as bradykinesia or muscular rigidity, AP is not always improved but rather deteriorated by PD medication. To clarify factors associated with neck and thoracolumbar AP. Neck flexion (NF) and thoracolumbar (TL) angles were measured in 216 consecutive PD patients and 175 elderly healthy controls. The differences in NF and TL angles between PD patients and controls were designated as ΔNFA and ΔTLA, respectively. The association of ΔNFA or ΔTLA and predictable factors such as age, sex, duration of PD, Hoehn Yahr (H-Y) stage, Unified Parkinson's Disease Rating Scale Part 3 (UPDRS-3), daily dose of dopamine agonists, and comorbid orthopedic spinal lesions was investigated in PD patients. Patients were divided into quartiles according to ΔNFA or ΔTLA. The association between predictable factors and ΔNFA or ΔTLA was estimated as odds ratio (OR), comparing with the lowest quartile as the reference by multivariate regression analysis. Compared with controls, distributions of all three posture angles were significantly shifted rightward in PD patients. Although there were no difference in UPDRS-3 scores in the quartiles of ΔNFA, the highest quartile was associated with H-Y stage ≥3 [OR 2.99, 95% confidence interval (CI) 1.33-6.70, p = 0.008] after adjustment for age, sex and comorbid orthopedic spinal lesions. The highest quartile of ΔTLA was associated with comorbid orthopedic spinal lesions [OR 5.83 (1.42-23.8), p = 0.014], and UPDRS-3 score [OR 3.04 (1.80-5.15)/10 points, p<0.0001]. Thoraco-lumbar AP was associated with UPDRS-3 scores and orthopedic spinal lesions, and in contrast, neck AP was not associated with these factors, suggesting that they had different pathomechanisms.PLoS ONE 12/2013; 8(9):e73547. DOI:10.1371/journal.pone.0073547 · 3.23 Impact Factor
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- "The results of our study indicate that increased muscle tone, particularly axial rigidity, is a principal cause of retrocollis in patients with PD. Dopaminergic drugs reportedly can induce or worsen antecollis in patients with PD   . In the present study, no significant difference of LED was found among PD patients with normal neck posture, antecollis and retrocollis. "
ABSTRACT: PURPOSE: To investigate the incidence of retrocollis and to determine its clinical correlates in patients with idiopathic Parkinson's disease (PD). METHODS: Seventy-four patients with PD at Hoehn and Yahr stage 5 were examined for abnormal neck postures and were classified according to neck posture. Differences in age, age at PD onset, disease duration, years from PD onset to Hoehn and Yahr stage 5, cognitive state, the levodopa equivalent dose (LED) for dopaminergic drugs, and rigidity of the neck and upper and lower extremities were examined to determine the clinical correlates of abnormal neck posture. We also evaluated retrocollis in 356 patients with PD at Hoehn and Yahr stage 1, 2, 3, and 4 and 65 age matched normal controls. RESULTS: Of the 74 patients with PD at Hoehn and Yahr stage 5 examined, 21 (28.4%) had retrocollis, 3 (4.1%) had antecollis, and 1 (1.4%) had antecollis and torticollis. Whereas, only one patient had retrocollis in PD patients at Hoehn and Yahr stage 4 and under. Patients with antecollis were significantly younger than those with normal neck posture and retrocollis. There were no differences in age at PD onset, disease duration, sex, years from PD motor symptom onset to Hoehn and Yahr stage 5, cognitive state, or LED between patients with and without abnormal neck postures. Neck rigidity scores were significantly higher in patients with retrocollis and antecollis than in those with normal neck posture. CONCLUSIONS: Retrocollis is not rare in patients with PD at Hoehn and Yahr stage 5, and the incidence appeared to increase as axial rigidity increased.Journal of the neurological sciences 11/2012; DOI:10.1016/j.jns.2012.10.011 · 2.26 Impact Factor
Conference Paper: Acceleration sensitivity of SAW and STW devices[Show abstract] [Hide abstract]
ABSTRACT: An analysis of the normal acceleration sensitivity of rotated Y-cut quartz SAW (Surface Acoustic Wave) and STW (Surface Transverse Wave) resonators simply supported along rectangular edges is presented. The analysis is based upon the perturbation integral formulation of Tiersten (1978), and makes use of the previously known analytic representation of the substrate deformation for the case considered. An approximate acoustic mode shape which accounts for spatial variations along all three axes is employed in the perturbation integral, allowing the derivation of analytic expressions relating the normal acceleration sensitivity to such parameters as substrate length, width, thickness, and orientation, mode center offset, mode shape spatial variations, etc. While the case considered represents something of an overestimate as compared to support configurations typically employed in production, questions regarding aspect-ratio compensation, optimum choice of substrate parameters, etc. are clarified by the case considered. The results of the analysis compare favorably with measurements of oscillators employing two-port SAW and STW resonatorsUltrasonics Symposium, 1995. Proceedings., 1995 IEEE; 12/1995