Publication:

Hallucinations and dyskinesia with pramipexole in parkinson’s disease-a case report

Pramipexole, a dopamine agonist has a tendency to induce psychotic symptoms, when used to treat Parkinson’s disease (PD). In most of the cases, patient’s psychosis developed after addition of Pramipexole and exacerbated after increasing the dosage. However there has been no case report in which Pramipexole has caused psychosis at lowest starting dose without any add on drug. Here we present a case of PD in which dyskinesia and psychosis appeared with first dose of Pramipexole, as low as 0.125mg. The patient was a 76 year old man with a one year history of PD. One year back patient observed tremors in his hand and slowing of movements. The neurologist prescribed Syndopa plus - 125, Benzhexol (schedule also same as Syndopa) and Pramipexole 0.125 mg at bedtime. The patient decided to start all medicines next day except Pramipexole (125mg) which he took at bed time. Within half an hour, patient started having visual and auditory hallucinations, along with abnormal movements and myoclonic jerks of hand, feet and mouth. He could be seen doing movements as if he is inserting needle in thread. According to him, he could visualize thieves trying to steal his car. Dechallenge with Pramipexole led to complete resolve of psychotic symptoms. After 4 weeks of therapy, there was a gradual but steady improvement in dyskinesia and tremors except slurring in speech.