衰老科学杂志

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A Rare Case of PAF Comorbid with Epilepsy: Differential Diagnosis and Treatment of a Patient in Charge at Outpatient Home Care Clinic

Zarola F*, Profeta B

Objective: A home care patient who was previously on outpatient clinic care with a suspicion of Parkinson's disease was taken in charge. The clinical history reported a poor response to dopaminergic therapy that had been interrupted at the initiative of the patient and his family. Therefore, the initial aim was a better diagnostic definition of a possible extrapyramidal disease and the development of a more effective treatment.

Background: During the previous home visits, some signs suggesting a Parkinsonism such as reduced facial expression and a certain motor slowdown with a slight axial stiffness were found, while along the way an orthostatic hypotension was added to clinical observation. A first new attempt with dopaminergic therapy had given little satisfaction, but in the meantime the presence of reported episodes of a 'lipothymic' type emerged. In order to verify the nature of these episodes, the patient performed tests electroencephalogram (EEG) that showed signs compatible with epilepsy.

Case: During the observation period the patient underwent to pressure measurement in ortho- clino-statism; the patient was subjected to EEG, electromyography (EMG), blood tests (B12 dosage) brain MR scan and DAT-Scan.

Results: From the tests performed, the patient resulted affected by epilepsy, a drastic drop in pressure when standing, signs of slight peripheral polyneuropathy, and positivity of the DAT-Scan due to a reduction in the uptake of the presynaptic tracer.

Conclusion: Therefore the patient was subjected to anti-epileptic therapy which resulted in a frequency reduction of episodes of consciousness loss, dopaminergic therapy at low doses, application of elastic stockings and hydration. To date, the patient has undergone a worsening evolution of the clinical picture relating to orthostatic hypotension.