Parkinsonism in cirrhotics

Burkhard PR et al. Arch Neurol 2003;60:521-528

 

Authors studied cirrhotics prospectively and found a unique Parkinsonian syndrome in 20 %.  Among 51 consecutive patients evaluated for liver transplant, 11 had Parkinsonism esp. stereotypical onset with generalized bradykinesia, dysarthira, postural instability, and prominent ACTION tremor.  Six had dystonia especially of face or feet.  Frontal findings were seen on neuropsych testing.  Levodopa resulted in improvement on UPDRS in 2 patietns.  CSF manganese was elevated in 3 patients in whom it was measured.  Allpatients had symmetric T1 abnormalities on MRI.  Liver transplantation reverses MRI findings.  Question arises of whether to chelate.