RT Book, Section A1 Aminoff, Michael J. A2 Katzung, Bertram G. SR Print(0) ID 1148436947 T1 Pharmacologic Management of Parkinsonism & Other Movement Disorders T2 Basic & Clinical Pharmacology, 14e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9781259641152 LK accessmedicine.mhmedical.com/content.aspx?aid=1148436947 RD 2024/10/14 AB CASE STUDYA 76-year-old retired banker complains of a shuffling gait with occasional falls over the last year. He has developed a stooped posture, drags his left leg when walking, and is unsteady on turning. He remains independent in all activities of daily living, but he has become more forgetful and occasionally sees his long-deceased father in his bedroom. Examination reveals hypomimia, hypophonia, a slight rest tremor of the right hand and chin, mild rigidity, and impaired rapid alternating movements in all limbs. Neurologic and general examinations are otherwise normal. What is the likely diagnosis and prognosis?The patient is started on a dopamine agonist, and the dose is gradually built up to the therapeutic range. Was this a good choice of medications?Six months later, the patient and his wife return for follow-up. It now becomes apparent that he is falling asleep at inappropriate times, such as at the dinner table, and when awake, he spends much of the time in arranging and rearranging the table cutlery or in picking at his clothes. To what is his condition due, and how should it be managed? Would you recommend surgical treatment?