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A 56-year-old man developed drug withdrawal syndrome and dropped head syndrome (DHS) during treatment with pramipexole, ropinirole and rotigotine.
The man with Parkinson's disease (PD) had an optimal response to the levodopa challenge. He was started on treatment with pramipexole and titrated up to 2.1 mg daily with improvement. However, after 18 month of treatment, he developed severe DHS within 4 days. His muscle enzymes CPK were increased and electromyography showed myopathic changes. His MRI showed T2 hyper-intensities of para-spinal and trapezius muscles. His muscle biopsy identified necrotising myopathy...