دانلود رایگان مقاله انگلیسی لوودوپای پاسخ دهنده در پارکینسون زودهنگام در سندرم داون - هینداوی 2018

Individuals with Down syndrome (DS) can develop Alzheimer’s disease as early as 30 to 40 years old, but parkinsonism is rarely described. We report on a 20-year-old woman with Down syndrome and parkinsonism who responded dramatically to carbidopalevodopa. We propose that the occurrence of parkinsonism in individuals with DS may be underreported. Recognizing and treating this condition may improve quality of life.

Conclusion

Tis young woman with Down syndrome (DS) presented with classical features of parkinsonism. She has maintained her response to levodopa for two years. Individuals with DS can get neurological complications from strokes, autoimmune disorders, moyamoya syndrome, endocrine dysfunction, epilepsy, or cervical cord compression, but these were excluded in our patient by appropriate testing. Our patient had a ventricular cyst that was initially concerning for normal pressure hydrocephalus (NPH) but she lacked other features of NPH such as bladder incontinence and the characteristic gait abnormality. In addition, she showed stable brain imaging over two years and responded dramatically to levodopa, making NPH unlikely. Her clinical fndings preceded treatment with antidepressant medication and do not seem medication-related. Familial PD usually occurs at a later age, though a family history was not available as the patient was adopted. It is debatable whether her citalopram-responsive depression was a manifestation of parkinsonism or a separate disease process. Regression in behavior triggered by a lifestyle change may also have responded to the SSRI, but her improvement with levodopa suggests the parkinsonism was an independent entity. Our patient is unique due to her young age of onset of parkinsonism, her dramatic and sustained response to levodopa, and the absence of cognitive decline. Individuals with DS who present with extrapyramidal symptoms may be mistaken to have psychomotor slowing due to Alzheimer’s; therefore, the occurrence of parkinsonism may be underreported. A multidisciplinary approach is useful in recognizing associated comorbidities such as depression. We recommend a trial of levodopa if parkinsonian features are observed on neurological examination in an individual with DS.