Rehabilitation for Parkinson Disease / The Japanese Journal of Rehabilitation Medicine

Patients with Parkinson disease present with a variety of symptoms as well as the so-called 4 classic symptoms : tremor, muscle rigidity, akinesia, and postural instability. To treat this disease, the best combination of various antiparkinsonism drugs, deep brain stimulation, and rehabilitation should be determined and administered. Muscular training in rehabilitation for patients should place great importance on some especially vulnerable muscles including the truncal muscles, extensor muscles for hip and knee joints, and dorsiflexor muscles for ankle joints. Shifting the center of gravity and using rhythmic movements are important factors in getting the patient standing and walking. Training using visual and auditory cues and music is effective in Parkinson disease. Speech therapy using weighted noise is also available. In rehabilitation we have to pay attention to cognitive function and psychiatric symptoms in patients including depression, anhedonia, hallucination, delusion, dopamine dysregulation syndrome, and impulse control disorder. What priority should be set for rehabilitation differs according to the stages of disease. Utmost efforts must be made for patients in the advanced stage of Parkinson disease to prevent them from being bedridden, tube-fed, and demented. Medical staff must be creative in coming up with new ideas to assist such patients in sitting comfortably on chairs for long periods and in eating by mouth safely.

Lees' syndrome: a case series / Síndrome de Lees: uma série de casos

We report a case series of dopamine dysregulation syndrome, previously known as hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies, now designated as Lees' syndrome.

Relatamos uma série de casos da síndrome de desregulação dopaminérgica, previamente conhecida como desregulação homeostática hedonística em pacientes com doença de Parkinson em uso de terapia de reposição dopaminérgica, e agora definida como síndrome de Lees.

A Case of Dopamine Dysregulation Syndrome and Repetitive Behavior Caused by Levodopa in Parkinson's Disease

Levodopa treatment in Parkinson's disease (PD) can cause a wide range of non-motor manifestations including poor impulse control and stereotyped behaviors. Punding is a term used to describe complex prolonged, purposeless and repetitive behavior in patients under dopamine replacement therapy. We report a 64-year-old PD patient who, concomitantly with self-increment of levodopa, developed punding behaviors in association with dopamine dysregulation syndrome. Gradual reduction of dopaminergic medication partially alleviated repetitive behavior over time.

A Case of Dopamine Dysregulation Syndrome with Concurrent Parkinsonism Hyperpyrexia Syndrome

A few patients with Parkinson's disease (PD) crave large amounts of levodopa therapy far beyond those needed to alleviate their symptoms, even in the state of overdose complication. Such harmful pattern of compulsive dopaminergic drug use is called as dopamine dysregulation syndrome (DDS). We report a chronic stage PD patient presenting with high fever and altered mentality, who had the DDS as well as the Parkinsonism hyperpyrexia syndrome (PHS).