Objective: In the treatment of Parkinson’s disease, dopamine agonists are among the preferred treatment options, particularly in the treatment of young Parkinson’s patients. The known side-effects of dopamine agonists include impulse control disorder, hallucinations, mania and delirium, suddenly falling asleep, somnolence, and dyskinesia. Hallucinations consist of mostly vivid visual hallucinations and rarely reported auditory hallucinations.

Background: 56 year-old, female, housewife; presented to us with tremor in the left hand and slowness of movement which have been present for approximately one year. In the neurological examination, she had mildly hypophonic speech and mild bradymimia. The left arm was bradykinetic. There was more pronounced rigidity in the elbows in the bilateral upper extremities and in the left arm. Reduction in associated movements was noticed on the left side. Resting tremor was observed in the left hand. Step length was reduced but balance and turns were fine. Cranial MRI findings within normal range were determined.

Method: Rasagiline treatment was initiated with a provisional diagnosis of idiopathic Parkinson’s disease. One month later, 0,375 mg pramipexole was added. 10 days later, the patient presented to our outpatient clinic. She reported a constant smell of urine and cigarettes that appeared 2 days after starting the pramipexole treatment. She said that these smells were not felt by the people around her and those in the same environment and that it caused great discomfort. Neither the patient nor the people who she lived together with smoked.

Results: The pramipexole treatment of the patient was stopped and the treatment was continued with rasagiline alone. 3 days after ceasing dopamine agonist use, the olfactory hallucinations fully resolved. Later, no side effects were observed in the patient who had ropinirole added to her treatment.

Conclusion: A case of visual hallucinations, agitation, and myoclonus that appeared with the use of high-dose pramipexole has been reported. Although visual and auditory hallucinations associated with dopamine agonist use have been reported as side effects, olfactory hallucinations have not been reported in the literature.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/olfactory-hallucinations-induced-by-pramipexole-treatment-in-parkinsons-disease/