Reactions 885 - 19 Jan 2002

★Antineoplastics

Parkinsonism (first report with busulfan, carboplatinand gemcitabine) treated with levodopa: 3 casereports

After receiving antineoplastic therapy [dosages not stated], 3women experienced parkinsonism, which was responsive totreatment with levodopa.

The first woman, aged 49 years, had breast cancer and wastreated with weekly gemcitabine [duration of treatment notstated]. She developed prominent bradykinesia, tremor at restand rigidity. She was treated with levodopa and her symptomsresolved.

The second woman, aged 75 years, developed parkinsonism1 week after receiving her second course of treatment withcarboplatin and paclitaxel [taxol] for squamous cell cancer.Three weeks later, she presented with severe hypophonia,generalised rigidity, bradykinesia and an inability to swallow.She was treated with levodopa and her symptoms improved tothe point that she was able to eat.

The third woman, aged 60 years, had chronic myelogenousleukaemia and was treated with cyclophosphamide[‘Cytoxan’] and busulfan. Four weeks after starting treatment,she developed parkinsonian rest tremor. When she presentedwith her symptoms, dysarthria, mild bradykinesia, stoopedposture and a shuffling gait were also evident. Treatment withlevodopa resulted in improvement in her tremor, gait andspeech disorder.

Author comment: ‘Chemotherapy-induced parkinsonismmay be an under-recognized source of disability amongoncology patients. Treatment with levodopa produced amarked, rapid improvement in symptoms, suggesting acommon predisposition of these agents to affect the pre-synaptic nigrostriatal pathway.’Chuang C, et al. Chemotherapy-induced parkinsonism responsive to levodopa: anunder-recognized entity? Movement Disorders 16: 990, Sep 2001 [abstract] -USA 800885906

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of parkinsonism associatedwith busulfan, carboplatin or gemcitabine. The WHO AdverseDrug Reactions database contains 3 and 2 reports ofextrapyramidal disorder associated with carboplatin andgemcitabine, respectively, and no such reports associated withbusulfan.

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Reactions 19 Jan 2002 No. 8850114-9954/10/0885-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved