2025 American Academy of Neurology Abstract Website

Objective:

To describe the characteristics of paroxysmal abdominalgia (PxA) as a "wearing off" (WO) phenomenon in patients with Parkinson’s disease (PD) in a series of four cases.

Background:

The WO phenomenon is a common complication of levodopa treated PD. Non-motor features, including psychiatric symptoms and sensory phenomena including pain, occur in approximately 40% of PD patients with WO. A rare feature is PxA, characterized by severe debilitating abdominal pain that dominates the off episode. When it occurs, other GI causes, such as gastroparesis or constipation should be are ruled out. There is limited literature on PxA in PD.

Design/Methods:

We conducted a retrospective chart review of four idiopathic PD patients at our institution who experienced PxA. Clinical data, including PD duration, stage, description of abdominal pain, related symptoms, and treatment history, are reviewed.

Results:

All four patients had long-standing PD, with Hoehn & Yahr stages ranging from 2 to 4. In each case, PxA onset was clearly linked to WO episodes, and with pain lasting for hours. The pain descriptions varied, including abdominal tightness, squeezing, twisting, and bloating. Concomitant panic attacks and anxiety were common. Despite attempts with multiple medications, including anxiolytics, dopaminergic rescue medications and long-acting carbidopa/levodopa formulations, all patients experienced inadequate symptom relief.

Conclusions:

PxA is a debilitating non-motor complication in PD that generally occurs with WO. It has variable presentation and associated symptoms, including anxiety and panic attacks. It frequently leads to emergency department visits and multiple GI workups. Treatment is currently limited. Further research is needed to better understand the mechanisms behind paroxysmal abdominalgia and develop more effective treatments.