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Mar15

A number of levodopa related conditions are described in patients with idiopathic parkinsons disease, of which yo-yo-ing is a very rare and difficult to treat entity. Yo-yo-ing is the extreme form of alternating offs and dyskinesias resulting from the the prolonged use of high dose of levododpa, where in, patient is more troubled by offs than dyskinesias. The term yo-yo-ing denotes frequent ups and downs of a yo-yo with virtually hardly any period of optimally good on. It is refractory to all modalities of available treatment, however, treatment with frequent sips of liquefied levodopa-carbidopa has been described, though infrequently used, which smoothen the dykinesias and keep the patient on. We had a 65 years old lady of advanced Parkinson disease with difficult dyskinesias and unpredictable offs (yo-yo-ing), who was non responsive to almost all the possible combinations and permutations of antiparkinsonian drugs. In the mean time she developed respiratory difficulty with poor effort  and CO2 retention, probably because of  exhaustion caused by unrelenting dyskinesias; for which she was shifted to MICU, intubated and put on ventilator. Along with other supportive care, liquefied levodopa-carbidopa in soda and ascorbic acid preparations was started in half hourly sips and the response was remarkable in terms of “offs and dyskinesias”. Gradually she was weaned off the ventilator, shifted back to ward and discharged. This case highlights the fact that at times unconventional method of drug administration do work and worth trying.



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