[Pure akinesia presenting with antecollis]

Area of Science:

• Neurology
• Pharmacology

Background:

• Pure akinesia is a rare disorder often pathologically linked to progressive supranuclear palsy or pallido-nigro-luysian atrophy.
• L-threo-3, 4-dihydroxyphenylserine (L-DOPS) is used to treat certain neurological conditions by increasing noradrenaline levels.

Observation:

• A 77-year-old woman with pure akinesia developed antecollis (dropped head) after initiating L-DOPS treatment.
• The patient experienced initial improvement in gait and unsteadiness with L-DOPS, but this effect was temporary.
• Antecollis resolved rapidly upon discontinuation of L-DOPS, with no other underlying cause identified.

Findings:

• L-DOPS administration was temporally associated with the onset of antecollis in a patient with pure akinesia.
• The mechanism is hypothesized to involve an imbalance between dopaminergic and noradrenergic systems due to L-DOPS.
• This is the first reported case of L-DOPS-induced antecollis in pure akinesia.

Implications:

• This case highlights a potential adverse effect of L-DOPS, specifically drug-induced dystonia (antecollis).
• It underscores the need for caution during L-DOPS therapy and careful monitoring for neurological side effects.
• Further research into the neurochemical mechanisms of L-DOPS-induced dystonia is warranted.