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June 2009

Olfactory Disturbance in Parkinson Disease

Arch Neurol. 2009;66(6):805-806. doi:10.1001/archneurol.2009.87

We read with interest the article by Landis and Burkhard titled “Phantosmias and Parkinson Disease.”1 We describe a 70-year-old man who initially developed infrequent bowel movements and constipation more than 3 years ago followed by symptoms consistent with rapid eye movement sleep behavior disorder and olfactory hallucinations for about 2.5 years. The phantosmias were constant initially but became intermittent after the onset of motor symptoms. The patient describes these as stinky and unpleasant. They have kept him home because he perceives them as body odor. There is no associated loss of awareness, confusion, automatisms, convulsive seizures, or visual or auditory hallucinations. He has no history of head injuries. Others are unable to smell these odors. His sense of smell is not as good as before, but his ability to taste is intact. Electroencephalography performed in June 2007 showed left temporal slow waves with intermixed sharp waves. Trials of levetiracetam slowly titrated to 750 mg twice daily and 10 mg of aripiprazole at bedtime failed to change these perceptions. Results of a repeat electroencephalogram when the patient was not receiving levetiracetam were normal. A left supination-pronation tremor, most prominent at rest, began about 2 years ago and responded to 25 mg of carbidopa and 100 mg of levodopa three times a day. Progressive cognitive problems with prominent difficulties in attention, multitasking, and visuospatial abilities developed over a few years.

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