Abstract
A 74-year-old woman visited our hospital complaining of unsteadiness in walking and clumsiness of the right hand. She had suffered from hypertension but otherwise had no previous history. She showed mild rigidity and akinesia in the right upper and lower extremities. Parkinson’s disease at Hoehn and Yahr stage 1 was diagnosed but medication was not prescribed. At age 78 she again visited our hospital complaining of worsening of gait disturbance and frequent falls. This time her Parkinsonian symptoms had developed to Hoehn and Yahr stage 3.5. Treatment with Levodopa/DCI and L-threo DOPS was started. Eight months later, she was admitted to another hospital because of severe abdominal pain. The abdominal pain emerged every afternoon and subsided after administration of pentazocine not non-steroidal anti-inflammatory drugs. Physical and endoscopic examination of the upper and lower gastrointestinal tracts showed no abnormality. Thirty-eight days after admission she was transferred to our hospital. The abdominal pain emerged every afternoon around 4 pm without presentation of any physical signs in the abdomen. The pain was assumed to be due to non-motor off sensory symptom. Thus, we administered levodopa/DCI at 3 pm, which abolished the pain completely. Lowered threshold for pain perception induced by reduction of monoaminergic transmission in the central nervous system may have been associated with the abdominal pain of the present patient.
