Aghamollaii V1, Bidaki R2,3*
1Department of Neuropsychiatry, Tehran University of Medical Sciences, Tehran, Iran 2Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 3Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
*Corresponding’s author: Reza Bidaki, Taft- Yazd- Comprehensive Psychiatry Center, Tehran, Iran, Tel: +98-(353)-263-2004; Fax: +98-(353)-263-2004; E-mail: Reza.Bidaki111@Gmail.com.
Received Date: November 28, 2020 Published Date: December 27, 2020 Copyright: Aghamollaii V, et al. © 2020. Citation: Aghamollaii V, et al. (2020). Dupuytren Contracture follow Prolong Use of Primidone in an Old Woman with Essential Tremor: A Clinical Image. Mathews J Emergency Med. (5)2:39.
Dupuytren’s contracture is a chronic fibrotic state related to progressive fibrosis of the palmar and plantar fascia. A 74 year old woman right handed with past history of anxiety , agitation and depression and prolonged use of Primidone because of essential tremor had preoccupation with dysfunction of hand. The little and ring fingers of right hand couldn’t be straightened completely, which complicate everyday activities such as grasping large objects or washing her face. As primidone is choice and first step about ET, therefore therapists should notice it.
KEYWORDS: Essential Tremor; Dupuytren’s Contracture; Depression; Anxiety
Dupuytren’s disease that involves collagen deposition and finally affects hand ability is related to collagen and fibroblasts . This disease affects woman less than man, younger more than old age [2,3]. Predispose factors are include alcohol use, smoking, human immunodeficiency virus, diabetes mellitus, epilepsy, genetics, and manual work . In some case reports, It is reported this condition follow long use of phenobarbital .
A 74 year old woman right handed with past history of anxiety, agitation and depression from 6 years ago and head tremor and social avoidance follow it from three years ago was referred to Neurology clinic. She was under treatment a psychiatrist for psychiatric problems by Tab. Venlafaxine 37.5 mg BID, Tab. Trazodone 50 mg at night, Tab. Melatonin 3 mg at night. Neurologist prescribed her Tab. Primidone 250 mg at night a, Cap. Gabapentine 300 mg at night and Tab. Baclofen 10 mg daily for tremor. Depression and anxiety were suitable response to Tab. Citalopram and Tab. Trazodone, ago. After augmentation of Syrup. Lyscantine 10 drops daily, she reported that her right fingers were closed and she should aid from other hand for opening of right hand 9 (Figure 1). She had hyperlipidemia in medical history. She hadn't substance use history.
Neurological findings were include: Positional tremor more in left hand, head tremor as no-no. There were not voice tremor, at rest and action tremor, dystonia and bradykinesia. Cerebellar examinations and gait were normal. In ulnar part, interoseus muscles were weak without palpation of fibrosis or nodule. Although, her ground mother was a Parkinson's disease patient, but she hadn't core feature of it.
Figure 1: Dupuytren’s Contracture follow Pyrimidone Use.
Probable etiology for finger movement limitation is prolonged use of Primidone at dosage 250 mg daily. In a report by Felipe et al. reported that an old man with essential tremor which progressed simultaneous Dupuytren, Ledderhose, and Peyronie diseases follow primidone use .
Dupuytren’s contracture is more common in male sex but our case was female without history of alcohol use, trauma and seizure. In examination, there isn’t weakness and involvement of ulnar nerve. But because of deep tissue involvement and fibrosis, motion of 4th and 5th finger was restricted. The little and ring fingers of right hand couldn’t be straightened completely, which complicate everyday activities such as grasping large objects or washing her face.
The appearance of skin on the palm was thickened dimpled but there was no evidence of firmness. She had preoccupation with this status and therefore, it was effective on depression and anxiety.
As primidone is choice and first step about ET, therefore therapists should notice it.
We thank of patient for her cooperation and consent.
Aghamollaii V examined and managed the patient and Bidaki R wrote primary draft and submitted it.
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