Anterocollis Worsened by Levodopa Therapy: A Case Report

Abstract

Introduction: Anterocollis was described in the Parkinson’s disease and was often indicated as responding well to levodopa therapy. This article, on the other side, investigates the case of a patient with anterocollis whose condition worsened because of the levodopa therapy. Case Presentation: A man suffering from Parkinson’s disease since the age of 63 years began presenting a subacute appearance of anterocollis at the age of 73 years. Clonazepam, botulinum toxin, and physiotherapy relieved the pain without improving the anterocollis, while the suspension of both pramipexole and domperidone proved ineffective. The washout of the levodopa for 12 hours caused a worsening of the PD but an improvement of anterocollis. All attempts to increase the posology of the levodopa led to an improvement of the PD but worsening of the anterocollis. Conclusions: Usually the anterocollis improves with levodopa, but in rare patients, levodopa therapy causes worsening of the anterocollis despite the improvement of rigidity.