Apraxia of lid opening: dose-dependent response to carbidopa-levodopa

Pharmacotherapy. 2004 Mar;24(3):401-3. doi: 10.1592/phco.24.4.401.33174.


A 67-year-old woman with an 8-year history of Parkinson's disease and Lewy body dementia experienced difficulty in opening her eyelids (apraxia of lid opening [ALO]); she could close them without difficulty. This problem emerged 2 weeks after the patient's dosage of carbidopa 50 mg-levodopa 200 mg 3 times/day was decreased to twice/day. Two weeks after the onset of ALO the patient visited her physician, who suspected carbidopa-levodopa of causing the problem; the drug was discontinued. When the patient's condition worsened rather than improved, she was referred to a neuro-ophthalmologist, who confirmed the diagnosis of ALO. However, the neuro-ophthalmologist noted that this may not have been a true apraxia but rather a form of sustained blepharospasm that prevented the eyelid from opening. Carbidopa-levodopa was restarted, and her condition improved dramatically when her dosage was increased gradually to carbidopa 50 mg-levodopa 200 mg in the morning and at noon, and carbidopa 25 mg-levodopa 100 mg in the evening. Clinicians should be aware of adverse reactions, such as AOL, in patients taking carbidopa-levodopa who have dementia of the Lewy body type.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Apraxia, Ideomotor / chemically induced
  • Apraxia, Ideomotor / complications
  • Apraxia, Ideomotor / diagnosis*
  • Blepharospasm / complications
  • Blepharospasm / prevention & control
  • Carbidopa / administration & dosage
  • Carbidopa / adverse effects*
  • Carbidopa / therapeutic use
  • Dose-Response Relationship, Drug*
  • Drug Administration Schedule
  • Drug Combinations
  • Eyelid Diseases / chemically induced*
  • Eyelids / drug effects
  • Eyelids / innervation*
  • Eyelids / physiopathology
  • Female
  • Humans
  • Levodopa / administration & dosage
  • Levodopa / adverse effects*
  • Levodopa / therapeutic use
  • Lewy Body Disease / complications
  • Lewy Body Disease / diagnosis
  • Time Factors


  • Drug Combinations
  • Levodopa
  • Carbidopa