Case study 1 patient history
Download
1 / 11

Case study 1 Patient history - PowerPoint PPT Presentation


  • 105 Views
  • Uploaded on

Case study 1 Patient history. Female retired farmer, born 1932 1988: pain right shoulder → physiotherapy, analgesics 1991: Parkinson‘s disease diagnosed, good levodopa response Around 1994: motor fluctuations Pergolide added, later → pramipexole

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Case study 1 Patient history' - felicia-armstrong


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Case study 1 patient history
Case study 1Patient history

  • Female retired farmer, born 1932

  • 1988: pain right shoulder → physiotherapy, analgesics

  • 1991: Parkinson‘s disease diagnosed, good levodopa response

  • Around 1994: motor fluctuations

  • Pergolide added, later → pramipexole

  • 2005: osteoporotic vertebral fracture → uses sticks for walking


Patient history treatment
Patient historyTreatment

  • Dyskinesias: choreatic, peak dose, socially embarrassing & physically disabling

  • ↑ Entacapone; amantadine: no effect

  • ‛Off’ time ~3 hours/day

  • Marked non-motor ‛off‘ symptoms: shoulder / back pain, dysphoria, anxiety

  • Medication:

    • ASS 100 mg

    • Alendronate 70 mg/wk

    • Levodopa/benserazide 200/50 ½ - ½ - ½ - ¼ - ¼ - ¼ - 0

      100/25 CR 1

    • Pramipexole 0.7mg 1 – 0 – 1 – 1 – 0 – 0 – 0

    • Oxycodone 10 mg ½ - 0 – 0 – 0 – 0 – 0 – ½


Discussion
Discussion

  • Q. Which factors should be considered in the next

  • treatment decision for this patient?

  • Q. Given the factors considered above, which treatment

  • would you select?


Results before apomorphine
ResultsBefore apomorphine


Results on subcutaneous apomorphine infusion treatment
ResultsOn subcutaneous apomorphine infusion treatment

Initiated February 2006


ResultsCurrent status

May 2008

  • Apomorphine: Flow rate: 7 mg/h; 14 hours/day

  • Morning: ½ levodopa/benserazide 200/50 + 1 soluble 100/25

  • Bedtime: ½ levodopa/benserazide 200/50

  • ¼ levodopa/benserazide 200/50 when required (~ 1/day)

  • Domperidone 60 mg/day

  • Oxycodone discontinued; non-motor ‘off’ problems much improved


ResultsCurrent status

Permission kindly granted by Dr Regina Katzenschlager


Case study 2 patient history
Case study 2Patient history

  • Social history: head of a department of transportation. Occasional work at night and odd hours. Active recreation activities; fishing, hunting, riding bicycle

  • PD diagnosis at age 50

  • After 1.5 years of L-dopa fluctuations, entacapone started with good effect, but diarrhoea (transient)  

  • Levodopa/benserazide 125 1½ x 6, cabergoline 6 mg /day, entacapone 200 mg tid 

  • 2006: mitral insufficiency  cabergoline stopped, pramipexole 1.05 mg tid

  • Levodopa/benserazide 125 x 7, levodopa/benserazide 62.5 x 4, soluble levodopa/benserazide 62.5 x 1, levodopa/benserazide SR 125 x 1; total L-dopa: 1.05 g / day

  • Fluctuations, no ‘on’, dystonic pain, slight hyperkinesias


Discussion1
Discussion

  • Q. Which factors should be considered in the next

  • treatment decision for this patient?

  • Q. Given the factors considered above, which treatment

  • would you select?


Patient history treatment1
Patient historyTreatment

  • August 2007: Apomorphine pump 6.8 mg/h, reduction of oral medication

  • August 2009: pump (7.25 mg/h) during waking hours. Fully active at work and with recreation activities. Uses pen if on call and called out in the night, and for dystonic leg cramps


Results current status
ResultsCurrent status

  • Sleeps through the night for the first time in years

  • No ‘off’ periods during waking hours. Feels independent

  • Medication:

    • Madopar 125 mg x 4, entacapone 200 mg x 4, Madopar SR 125 mg x 2;

    • Total L-dopa reduction: 62 %

  • Side effects:

    • Small skin nodules


  • ad