Objective: To describe a case of a man with Parkinson’s disease (PD), who was developed dopamine dysregulation syndrome (DDS) after COVID-19.

Background: Parkinson’s disease is a progressive neurodegenerative disorder. Complication of treatment of PD is motor fluctuations and dyskinesias, dopamine dysregulation syndrome (compulsive use of dopaminergic drug) and impulse control disorders, different sleep disturbances and REM sleep behavior disorders.

Method: case report

Results: A 47-years old man presented to our clinic with 7 years history of PD. We know that patient has alcohol abused. Patient complained of stiffness and slowness of movement. On examination patient had significant instability without falls, severe movement disability. He had severe hypomimia, asymmetrical bradykinesia (left>right), and rigidity (left>right). There were no rest or postural tremor. He walked on a narrow base with help of relatives. He had severe non-motor aspects such as severe speech impair, drooling, severe swallowing and chewing. Also patient described illusions in “OFF”-period. Duration “OFF”-period was 40-60 min after patient had taken the medicine and 40 min before taking a new dose of drug. UPDRS on “OFF”-period: 88. Patient accepted levodopa/benserazide 200mg+50mg 1 tabs 3 times a day, pramipexole 1mg 3 times a day, midantane 100mg 3 times a day.
On November 2020 patient has suffered COVID-19. After this infection episode patient received his medication arregular, sometimes he could take levodopa/benserazide 200mg+50mg 8-10 times a day. When he had taken new dose of levodopa/benserazide, he had behavioral disorders such as euphoria, impulse control disorders like a hypersexuality, sleer disturbance appeared, REM sleep behavior disorders, nocturnal akinesia also appeared.
We changed treatment for this patient. It was discontinuation pramipexole and midantane, shortening the dosing interval but increase frequent doses of levodopa/benserazide 200mg+50mg ½ tab 9 times a day, added quetiapine 25mg 1\2 tabs et night. One weeks later motor fluctuation and DDS decreased. Although REM sleep behavior disorders was persisted

Conclusion: Patient with early onset of PD, early started levodopatherapy and development complication of dopaminergic drug therapy such as motor fluctuation, DDS, sleep disturbances after episode of COVID-19. In this case it was showed that COVID-19 can provoked earlier development of complication dopaminergic drug therapy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopamine-dysregulation-syndrome-in-parkinsons-disease-after-covid-19-case-report/