He was treated with rasagiline 1mg daily but experienced a progression of the disease and also developed restless leg symptoms; amantadine was added to mitigate symptoms. The progression of symptoms continued bilaterally and pramipexole was initiated in 2010. In 2013, carbidopa-levodopa treatment was started. The patient has shown robust and durable responsiveness to dopaminergic therapies and has developed no motor complications to date.

The second case study concerns a 71-year-old male, art museum director who was evaluated for a tremor in 2003. His history included exposure to pesticide bombs in the 1950s, lumbar-sacral radiculopathy, and resolved hepatitis B and chronic hepatitis C genotype 1b with cirrhosis. His clinical course was similar to the patient detailed in the first case study. For hepatitis C he took interferon alpha-2b in 1992 and 1994, which moved to interferon alpha-2b with ribavirin in 1997 to 1998, to consensus interferon in 1999 to 2000, and pegylated interferon alpha-2a with ribavirin in 2001 to 2002. None of these provided sustained virologic responses.

Tremor was first noted in the patient in 1999 after 8 weeks of treatment with consensus interferon. At the end of 48 weeks of this treatment, the tremor was no longer noted. Then, 24 weeks after treatment stopped the tremor returned and was persistent. In 2003, after complaining of progressive tremor of the arms, legs, and jaw among other symptoms, the patient was diagnosed idiopathic PD, Hoehn and Yahr stage II. He was started on carbidopa-levodopa, and responded well. Fludrocortisone was added to control orthostatic blood pressure as was ropinirole for Restless Legs Syndrome. He was diagnosed with hepatocellular carcinoma in 2012. Although his PD was slowly progressive (10–11 years since initial symptoms), he continued to respond to dopaminergic therapy. In 2014, substantial dyskinesias began, his overall health declined and with the progressive tumor his condition deteriorated. He died in the fall of 2014.

Continue Reading