[Akathisia secondary to tolcapone. Report of a case]

The purpose of this work is to report a case of tolcapone-induced akathisia. A 39-year-old woman with Parkinson's disease, Hohen-Yahr IV, Webster 18 points with 10 years within onset, presented lack of clinical response to levodopa-carbidopa, pergolide, selegiline and trihexiphenidyl, showing freezing and wearing-off phenomena and choreic dyskinetic abnormal movements of the upper and lower extremities, during the six months previous to her evaluation. Her hepatic function was normal. Levodopa-carbidopa and selegiline were diminished to add tolcapone, as described elsewhere. During the first three weeks, the patient showed marked clinical improvement of previous complications and sustained improvement during 12.5 weeks. At the 13th week of tolcapone therapy the patient developed constant orofacial, trunk, and superior and lower limb ínvoluntary movements associated to lack of stand still. Laboratory tests showed discrete elevation of oxaloacetic-glutamic transminase, direct bilirrubin, indirect bilirubin, and alkaline phosphatase. Electroencephalogram and CT scan were normal. Tolcapone therapy was finished, and levodopa-carbidopa, pergolide and selegiline were diminished, procuring the disappearance of akathisia within 72 h.