Lewy body Parkinson’s disease in a familial case: What is idiopathic Parkinson’s disease?

CASE PRESENTATION At the age of 49 years, this right-handed carpenter first noticed a slight resting tremor in both arms that spread to both lower limbs 3 years later. At this stage, generalized bradykinesia and rigidity had also developed, and a diagnosis of Parkinson's disease (PD) was made. He was started on levodopa (100 mg three times a day), resulting in marked and long-standing improvement of his signs and symptoms that were very slowly progressive. Fourteen years later, now aged 63 years, his gait had worsened and was complicated by frequent freezing episodes. At the same time, he began to experience motor fluctuations consisting of wearing-off, random on-off episodes, and mild peak-dose dyskinesias.