Bromocriptine and L-Dopa Therapy: Comparison in a Case of Hereditary Progressive Dystonia with Marked Diurnal Fluctuation

Abstract

A case of 14-year-old female with hereditary progressive dystonia with marked diurnal fluctuation (HPD) was presented. After the onset at 6 years, she developed progressive dystonia of extremities which worsened towards evening. Treatment with bromocriptine (15mg/day) markedly improved the symptoms. L-dopa therapy was also attempted and no deterioration was found.
We measured the number of body movements during sleep by all night polysomnography. Body movements which had been reduced before treatment showed a marked increase in number and their distribution in each sleep stage was also normalized after treatment. Serum growth hormone peak in the initial slow sleep was not found before treatment and after L-dopa therapy. Serum prolactin level was markedly suppressed during bromocriptine therapy, but no suppression was seen after L-dopa therapy.
Bromocriptine is effective to HPD and its use as an alternative to L-dopa would be possible. There were some differences in the effects on body movements and serum pituitary hormone levels between bromocriptine and L-dopa therapy. This may show the multiplicity of dopaminergic neuron receptors.