ABSTRACT
CASE PRESENTATION A 69-year-old man with a 9-year history of parkinsonism presented with marked worsening of tremor, rigidity, gait, and balance over the last 18 months. He had been diagnosed with Parkinson’s disease 7 years ago following gradual progression of the initial symptoms of resting tremor affecting the right arm and generalized slowing. He responded to treatment with a dopamine receptor agonist, selegiline, and amantadine. Levodopa had been introduced 2 years ago with marked improvement. Over the last year-and-a-half, his condition had deteriorated dramatically, with the emergence of frequent freezing, falling, and the inability to walk or perform most activities of daily living without assistance. Multiple visits for medical evaluations during this period of decline resulted in several increases of levodopa from the initial dose of 300 mg to the current dose of 1250 mg per day with no apparent benefit.
