Parkinsonism and Related Disorders 21 (2015) 426
Contents lists available at ScienceDirect
Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis
Correspondence
Entacapone, Parkinson's disease, “functional adrenergic denervation”, and Takotsubo syndrome Keywords: Takotsubo syndrome Parkinson's disease Entacapone Autonomic sympathetic nervous system Dysautonomia Cardiac sympathetic denervation
functional, i.e., reversible in patients with TTS, although it may take long time for complete normalization [3], in contrast to the case of the present patient with PD, which was permanent, since it was present prior to the administration of ENTA, which resulted in TTS. Conflicts of interest None.
To the Editor The fascinating report by Baldacci et al. [1], published ahead of print, on September 16, 2014 in the Journal, about the 68-year-old woman with Parkinson's disease (PD) who suffered Takotsubo syndrome (TTS), 4 days after starting entacapone (ENTA), a catecholamine augmenting inhibitor of c-COMT activity, provides plenty of food for thought. The case for TTS is herein well documented, such brief episodes, manifesting by rapid normalization of the left ventricular function, have been previously reported, and the absence of electrocardiographic abnormalities may be due to the non-development of myocardial edema [2], due to the brief duration of the illness. I am puzzled by the PD clinical stability of the patient for a period of one year, after the episode of TTS, while taking the same medications she was on, when she was felt that “she had not been responding well to DA therapy for last 6 months”, save for a reduction of the dose of ropinirole by half, and the addition of daily 2.5 mg of bisoprolol. In reference to the pathophysiologic connotations for TTS, the patient, as per authors “had a reduced cardiac MIBG uptake before shifting to entacapone therapy, in keeping with the well-known abnormal cardiac noradrenergic denervation in PD patients, “suggesting some analogy with myocardial dysautonomia in PD patients”. The “functional alteration in presynaptic sympathetic neurotransmission” which “has been previously described in patients with TTS” is truly
DOI of original article: http://dx.doi.org/10.1016/j.parkreldis.2014.11.010. http://dx.doi.org/10.1016/j.parkreldis.2014.11.011 1353-8020/© 2014 Elsevier Ltd. All rights reserved.
References [1] Baldacci F, Vergallo A, Del Dotto P, Ulivi M, Palombo C, Casolo G, et al. Occurrence of Takotsubo syndrome in a patient with Parkinson's disease after entacapone add-on. S1353e8020(14)00331-9 Park Relat Disord 2014 Sep 16. http:// dx.doi.org/10.1016/j.parkreldis.2014.09.009 [Epub ahead of print]. [2] Perazzolo Marra M, Zorzi A, Corbetti F, De Lazzari M, Migliore F, Tona F, et al. Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens' ECG pattern) in Tako-Tsubo cardiomyopathy. Heart Rhythm 2013;10:70e7. [3] Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Musha H, Sasaka K. 123I-MIBG myocardial scintigraphy in patients with “takotsubo” cardiomyopathy. J Nucl Med 2004;45:1121e7.
John E. Madias* Icahn School of Medicine at Mount Sinai, New York, NY, USA The Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA *
The Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA. Tel.: þ1 718 334 5005; fax: þ1 718 334 5990. E-mail address: [email protected]. 27 September 2014
Contents lists available at ScienceDirect
Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis
Correspondence
Entacapone, Parkinson's disease, “functional adrenergic denervation”, and Takotsubo syndrome Keywords: Takotsubo syndrome Parkinson's disease Entacapone Autonomic sympathetic nervous system Dysautonomia Cardiac sympathetic denervation
functional, i.e., reversible in patients with TTS, although it may take long time for complete normalization [3], in contrast to the case of the present patient with PD, which was permanent, since it was present prior to the administration of ENTA, which resulted in TTS. Conflicts of interest None.
To the Editor The fascinating report by Baldacci et al. [1], published ahead of print, on September 16, 2014 in the Journal, about the 68-year-old woman with Parkinson's disease (PD) who suffered Takotsubo syndrome (TTS), 4 days after starting entacapone (ENTA), a catecholamine augmenting inhibitor of c-COMT activity, provides plenty of food for thought. The case for TTS is herein well documented, such brief episodes, manifesting by rapid normalization of the left ventricular function, have been previously reported, and the absence of electrocardiographic abnormalities may be due to the non-development of myocardial edema [2], due to the brief duration of the illness. I am puzzled by the PD clinical stability of the patient for a period of one year, after the episode of TTS, while taking the same medications she was on, when she was felt that “she had not been responding well to DA therapy for last 6 months”, save for a reduction of the dose of ropinirole by half, and the addition of daily 2.5 mg of bisoprolol. In reference to the pathophysiologic connotations for TTS, the patient, as per authors “had a reduced cardiac MIBG uptake before shifting to entacapone therapy, in keeping with the well-known abnormal cardiac noradrenergic denervation in PD patients, “suggesting some analogy with myocardial dysautonomia in PD patients”. The “functional alteration in presynaptic sympathetic neurotransmission” which “has been previously described in patients with TTS” is truly
DOI of original article: http://dx.doi.org/10.1016/j.parkreldis.2014.11.010. http://dx.doi.org/10.1016/j.parkreldis.2014.11.011 1353-8020/© 2014 Elsevier Ltd. All rights reserved.
References [1] Baldacci F, Vergallo A, Del Dotto P, Ulivi M, Palombo C, Casolo G, et al. Occurrence of Takotsubo syndrome in a patient with Parkinson's disease after entacapone add-on. S1353e8020(14)00331-9 Park Relat Disord 2014 Sep 16. http:// dx.doi.org/10.1016/j.parkreldis.2014.09.009 [Epub ahead of print]. [2] Perazzolo Marra M, Zorzi A, Corbetti F, De Lazzari M, Migliore F, Tona F, et al. Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens' ECG pattern) in Tako-Tsubo cardiomyopathy. Heart Rhythm 2013;10:70e7. [3] Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Musha H, Sasaka K. 123I-MIBG myocardial scintigraphy in patients with “takotsubo” cardiomyopathy. J Nucl Med 2004;45:1121e7.
John E. Madias* Icahn School of Medicine at Mount Sinai, New York, NY, USA The Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA *
The Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA. Tel.: þ1 718 334 5005; fax: þ1 718 334 5990. E-mail address: [email protected]. 27 September 2014
