Internet dyskinesias in Parkinson’s disease

CASE PRESENTATION A 52-year-old man reported an 8-month history of slowed movements in both upper extremities, associated with mild hand tremor present at rest and with action. He also dragged his right leg while walking, and had stiffness in both legs. The patient’s father-in-law had a long-standing history of Parkinson’s disease (PD) and took levodopa. The patient diagnosed himself with PD, and began taking his father-in-law’s medications. He had minimal benefit from carbidopa/levodopa 25/100-mg tablets, and so titrated the dosage on his own to 25/250 mg every 2 hours for a total of 8-10 tablets per day. He began ordering the medication over the Internet without a prescription and without consulting a physician. Three months later, he began experiencing involuntary restless movements that interfered with ambulation. These worsened as each dose of carbidopa/levodopa wore off and at the end of the day.