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- Nirmalan Arulanantham, Ralph Wing Fung Lee, and Tom Hayton.
- the Great Western Hospital, Swindon, UK; previously specialist registrar, Department of Clinical Pharmacology and General Medicine, Queen Elizabeth Hospital, Birmingham, UK and honorary lecturer, Department of Clinical Pharmacology, University of Birmingham, UK nirmalan.arulanantham@doctors.org.uk.
- Clin Med. 2014 Aug 1; 14 (4): 449451449-51.
AbstractAlthough motor fluctuation can often be severe in Parkinson's disease (PD), it is rare for an 'off period' to result in coma. The case presented here is of a patient with longstanding PD who was admitted to our hospital with a Glasgow Coma Scale of three after missing just one or two doses of her medication. Investigation for infective, neurovascular and metabolic causes of coma were negative and the patient recovered very rapidly following reinstitution of dopaminergic therapy via nasogastric tube. This case highlights how florid the presentation of motor fluctuations in PD can be and the importance of restarting treatment as quickly as possible. Guidance is provided on how to administer dopaminergic medications in patients who are unable to swallow.© 2014 Royal College of Physicians.
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