Objective: To report an interesting initial presentation of PD causing refractory epilepsy.

Background: A lady with refractory depression, presented with first seizure at age 42, reviewed after 3rd seizure 3 years later. Lithium was withdrawn and lamotrigine started, MRI, SDEEG were normal.

Methods: Seizures increased with complex partial seizures (CPS), no lateralizing symptoms. Patient was compliant on lamotrigine 200 mg bd. Lamotrigine was increased to 300 mg bd and levetiracetam added 1500 mg bd. She had a few months with no GTC seizures (used to be weekly) and seldom CPS (used to be a dozen/month), still low appetite, depression and weight loss. 6 months later, she had very frequent GTC seizures, with multiple hospital admission.

Results: Her written diary was tremulous micrographic with mild right bradykinesia and cogwheel rigidity with distraction. DaT was negative. A trial of co-beneldopa was consented 50/12.5 mg qds with marked improvement of her motor and mood symptoms, 2 CPS only over 3 months. Zonisamide was added in a small dose 100 mg od to help with parkinsonian tremor, subsequently no more seizures or tremor.

Conclusions: Gastroparesis might be one of the early non-motor symptoms of idiopathic Parkinson disease with subsequent sub-therapeutic absorption of various AEDs and recurrence of frequent clinical seizures. It is a difficult hardly sought cause for gastroparesis, however it is quite treatable cause with marked symptom improvement both for PD and epilepsy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptom-in-young-onset-parkinson-disease-as-a-cause-of-pharmacoresistence-in-epilepsy/