Symptom improvement in a South Asian patient with Parkinson’s disease treated with immediate- and extended-release carbidopa–levodopa: a case report
Notice bibliographique
Résumé
BACKGROUND: Little is reported in literature about Parkinson's disease and treatment responses among South Asians. CASE PRESENTATION: Under the supervision of a movement disorders neurologist, an 85-year-old South Asian American man in hospice care was sufficiently regenerated from an adjustment of medications for Parkinson's disease, such that he was able to shift from being immobile, unable to speak, or safely eat and drink fluids orally, to walking, eating, drinking fluids, and communicating again. His initial symptoms motivated him to seek neurological care in 2012, with his first consultation with a movement disorders neurologist occurring in 2023. After receiving specialty care and adjusting his carbidopa-levodopa from immediate release to a combination short- and long-acting formulation, Rytary, he was discharged from hospice to home health care. He progressed from being almost entirely nonverbal, bed-bound, and solely dependent on artificial nutrition to supportive home-based physical therapy, which facilitated his ability to regain sufficient strength for ambulation, eating and drinking orally, and he can once again use expressive language. CONCLUSION: Immediate-release carbidopa-levodopa given three to four times daily remains the most common medication regimen for managing Parkinson's disease symptoms of tremor and rigidity, with benefits noted in responsive patients for 2 to 3 hours. Extended release and combination formulations of carbidopa-levodopa that combine short- and long-acting medications in one capsule provide symptom relief for responsive patients for 4-6 hours and should be considered when the benefit from immediate-release carbidopa-levodopa is limited. Little has previously been published about the potential for variations in carbidopa-levodopa formulation responsiveness in South Asians, though it has been suggested that Western guidelines for managing "off" periods where carbidopa-levodopa is less effective, may not apply to other ethnicities (Bhidayasiri et al. in Expert Rev Neurother 15(11):1285-1297, 2015). As exemplified in this case, greater understanding of non-Caucasian races' responses to carbidopa-levodopa, extended release, and their combination formulas is needed as is the benefit from subspecialty care within neurology, where the art of medication management is enhanced by experience in movement disorders and where objective tools such as the Movement Disorder Society-Unified Parkinson's Disease Rating Scale can measure stability, decline, or improvement within each patient pertaining to their activities of daily living, cognitive and motor functions impacted by Parkinson's disease, as well as monitoring for adverse reactions to medications used for Parkinson's disease, such as dyskinesias.
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».