Levodopa-induced myocardial infarction in a patient with Parkinson’s disease and severe coronary artery disease

Levodopa is the most effective medical treatment for Parkinson’s disease (PD) to date. As dopamine is known to increase cardiac inotropism and vasomotor tone, peripheral dopamine decarboxylase inhibitor is coadministered to suppress the peripheral conversion of levodopa to dopamine. Levodopa poses potential cardiovascular risks, thus its use in patients with existing coronary artery disease needs to be carefully monitored. We report a case of an elderly male with newly diagnosed PD who developed non-ST-elevation myocardial infarction following levodopa (Madopar) initiation.

The Clinical Frailty Scale predicts inpatient mortality in older hospitalised patients with idiopathic Parkinson’s disease


Parkinson’s disease and frailty are both common conditions affecting older people. Little is known regarding the association of the Clinical Frailty Scale with hospital outcomes in idiopathic Parkinson’s disease patients admitted to the acute hospital. We aimed to test whether frailty status was an independent predictor of short-term mortality and other hospital outcomes in older inpatients with idiopathic Parkinson’s disease.

Respiratory dysfunction in Parkinson’s disease

Respiratory dysfunction has been associated with Parkinson’s disease since it was first described in 1817. The respiratory symptoms observed in Parkinson’s disease patients vary greatly. Most patients remain asymptomatic, whereas others present with acute shortness of breath and even stridor.

In August 2016, an electronic literature search was conducted using PubMed and Google Scholar. Results were screened and studies reporting on respiratory dysfunction associated with Parkinson’s disease were included.

Seven cases of sigmoid volvulus in Parkinson’s disease

Non-motor features of Parkinson’s disease are receiving greater recognition. Constipation affects up to 50% of patients with Parkinson’s disease and sigmoid volvulus remains an under recognised complication with mortality rates up to 50%. The incidence of sigmoid volvulus in the general population is 1.7/100,000/year. The specific incidence in Parkinson’s disease is not known; however, this case series suggests that it is noticeably more than in the general population at 100/100,000/year.

Advances in the treatment of the motor symptoms of Parkinson’s disease

Parkinson’s disease is a chronic progressive neurodegenerative condition. It damages central nervous system dopaminergic but also serotonergic and noradrenergic pathways. There is no known cure, and no existing therapy has been proven to slow or reverse progress of the disease. Treatment aims to alleviate symptoms and preserve functional independence while minimising adverse affects.

Keywords Dopaminergic stimulation, motor symptoms, neuroprotection, neuroregeneration, Parkinson’s disease

Stockton-on-Tees symposium: Recent advances in medicine

This symposium provided an update on recent advances in medicine relevant to the general physician. The opening session on respiratory medicine session focused on lung cancer and lung transplantation. Everyday practical issues of dealing with abnormal liver function tests were considered in session two as well as the challenges in improving end-of-life care. Clinically orientated presentations in the third session covered case-based discussions on severe metabolic acidosis and the management of Parkinson’s disease.

A readability assessment of online Parkinson’s disease information

Background: Patients increasingly use the internet to access health information. Inadequate health literacy is common and frequently limits patient comprehension of healthcare literature. We aimed to assess the readability of online consumerorientated Parkinson’s disease (PD) information using two validated measures.

Method: We identified the 100 highest ranked consumer-orientated PD webpages and determined webpage readability using the Flesch-Kincaid and Simple Measure Of Gobbledygook (SMOG) formulae.

Management of Parkinson’s disease in the acute hospital environment

This review is based in part on Dr D MacMahon’s lecture at the RCPE Care of the Elderly Symposium held in Edinburgh on 30 March 2012.There have been a number of exciting developments in the management of Parkinson’s disease (PD) in the past decade. However the objective for the vast majority of patients remains the maintenance of quality of life through the achievement of steady levels of dopaminergic stimulation within the target neurones of the basal ganglia.