Objective: Our main objective is to illustrate different etiologies for paresthesia and gait impairment that can occur in a patient with Parkinson disease. We present the case of  a 60-year-old Caucasian man with advanced Parkinson’s disease in treatment with levodopa-carbidopa intestinal gel infusion (LCIG), that came to our hospital at his last 6 month follow up complaining of paresthesia at his lower limbs and gait impairment.

Background: Parkinson’s disease (PD) is a long-term degenerative disorder of the central nervous system, that affects predominately dopamine-producing neurons and can generate both motor and non-motor symptoms.

Method: The clinical examination revealed anesthesia for vibratory and mioartrokinetic sense in both of his lower limbs. Regarding BP, he had short episodes of  bradykinesia and dystonia in off with a UPDRS score of 37 point in on. The paraclinic tests performed to determine the etiology of paresthesia consisted in blood tests, cerebral CT scan, EMG and lombar IRM. Because the blood concentration of vitamin B12 was low we tested the antibodies against parietal cell and intrinsec factor that excluded Biermann anemia and performed an EMG that showed a moderate motor and sensitive axonal polyneuropathy. The normal cerebral CT scan excluded an upper motor neuron disease and the lombar IRM although showed a L1-S1 disc herniation with L3 radicular contact, the symptoms did not respect the radicular distribution and so it was excluded a posterior spinal cord column lesion.

Results: The particularity of this case is illustrated by the etiology of the gait disorder and the false positive Babinski sign that in the end turned out to be dystonic postures in the off periods. Another interesting aspect illustrated by this patient is the relationship between Parkinson disease- vitamin B12 deficiency- polyneuropathy.

Conclusion: All Parkinson patients exposed for a long period of time to high doses of dopaminergic medications that show signs of polyneuropathy should be tested for vitamin B12 deficiency, although it is said that this can be consider non-motor manifestation and sign of disease progression.

References: 1. Ashour R, Tintner R, Jankovic J. Striatal deformities of the hand and foot in Parkinson’s disease. Lancet Neurol 2005;4:423– 431. 2. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004;127: 2360 –2372. 3. Peripheral neuropathy in Parkinson’s disease: Levodopa exposure and implications for duodenal delivery-Parkinsonism and Related Disorders 19 (2013) 501e507 Thomas Müller a, *, Teus van Laar b , David R. Cornblath c , Per Odin d , Fabian Klostermann e , Francisco J. Grandas f , Georg Ebersbach g , Peter P. Urban h , Francesc Valldeoriola i , Angelo Antonini j 4. Brain Behav. 2017 May; 7(5): e00698. Effects of levodopa/carbidopa intestinal gel versus oral levodopa/carbidopa on B vitamin levels and neuropathy- Sebastian Loens, 1 Elena Chorbadzhieva, 1 Alexandra Kleimann, 2 Dirk Dressler, 1 and Christoph Schrader 1 5. Peripheral nervous system involvement in Parkinson’s disease: Evidence and controversies C. Comi a, c, * , L. Magistrelli a , G.D. Oggioni a , M. Carecchio a , T. Fleetwood a , R. Cantello a , F. Mancini b , A. Antonini d- Journal of Neurology December 2006, Volume 253, Supplement 7, pp vii38–vii41| Cite as Weight loss in Parkinson’s disease 6. Effects of levodopa/carbidopa intestinal gel versus oral levodopa/carbidopa on B vitamin levels and neuropathy:-Sebastian Loens1 | Elena Chorbadzhieva1 | Alexandra Kleimann2 | Dirk Dressler1 |Christoph Schrader1: Brain and Behaiviour 7. Actualitati in diagnosticul si tratamentul Bolii Parkinson- Ovidiu Bajenaru, ed Media Med Publicis 2010 8. Adams and Victor’s principles of neurology

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MDS Abstracts - https://www.mdsabstracts.org/abstract/paresthesia-and-gait-impairment-in-a-patient-with-advanced-parkinson-disease-case-report/