Case study 1 patient history
This presentation is the property of its rightful owner.
Sponsored Links
1 / 11

Case study 1 Patient history PowerPoint PPT Presentation


  • 71 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

Case study 1 Patient history

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


Case study 1 patient history

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


Case study 1 patient history

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


  • Login