This study provides Class I evidence that paroxetine and venlafaxine XR are effective in treating depression in patients with PD.

Sialorrhea is a relatively common symptom in idiopathic Parkinson's disease and related conditions for which most of the accepted treatments are either highly invasive or may cause substantial systemic side effects. This study describes an open-label pilot study of sublingual atropine drops for the treatment of sialorrhea in 7 patients (6 with Parkinson's disease, 1 with progressive supranuclear palsy). Participants demonstrated statistically significant declines in saliva production, both objectively and subjectively. Self-reported drooling severity showed a significant decline between baseline and 180 minutes, t(6) = 3.240 P < 0.025 (eta(2) = 0.636), and between baseline and 1 week, t(6) = 4.583 P < 0.005 (eta(2) = 0.778). Objectively measured saliva production decreased significantly between baseline and the 1-week follow-up, t(6) = 2.711 P < 0.05 (eta(2) = 0.551). Delirium occurred in 1 patient (concurrent with a urinary tract infection), and 2 patients experienced worsening of hallucinations (active hallucinosis was concealed by both individuals to allow participation in the trial). The remaining trial participants did not experience any anticholinergic side effects. This trial shows that, in selected patient populations, sublingual atropine is a simple and inexpensive treatment for sialorrhea associated with parkinsonism.

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The following outlines the case of a 60-year-old man presenting with ataxia and bradycardia as a consequence of a lateral medullary syndrome.A 60-year-old right-handed man presented with a witnessed sudden loss of right arm coordination followed by brief loss of consciousness. Prior to symptom onset, while eating with his wife, the patient was suddenly unable to coordinate his fork, held in his right hand, between his plate and his mouth. He felt faint, his vision clouded and sounds became distant. The patient lost consciousness for a few seconds and fell onto the floor. Immediately upon awakening, he was alert and oriented. There was no tongue biting or urinary or fecal incontinence.On initial assessment by paramedics the patient was dysarthric, had right-sided clumsiness and was profoundly bradycardic but normotensive (heart rate: 26 bpm, Figure 1). The dysarthria and clumsiness continued and diplopia (worse on right lateral gaze) and oscillopsia developed.Past medical history included remote tonsillectomy and measles as a child. There was no history of smoking, alcohol consumption, diabetes mellitus, ischemic heart disease, hypertension or previous stroke. The patient was not taking any medications, alternative therapies, or illicit drugs. He did not have any known allergies.On arrival in the emergency department, physical examination revealed a blood pressure of 140/74 mmHg, respiratory rate within normal limits and normal oxygen saturations. The heart rate was initially 26 beats per minute with a normal QRS complex and ST segment on electrocardiogram. Upon arrival in the emergency department, the electrocardiogram demonstrated a heart rate of 58 beats per minute with sinus rhythm. Recovery of heart rate and blood pressure occurred without medical intervention. Despite the bradyarrhythmia, heart sounds were normal with no added sounds or murmurs. Breath sounds were normal bilaterally and the abdomen was soft.The patient was alert and oriented to person, place and time. Cranial nerve examination demonstrated full extraocular movements. Left beating horizontal nystagmus was present in primary position and in all directions of gaze. Right-sided partial ptosis was present, with a right pupil measuring 3 mm and a left pupil measuring 3.5 mm in bright light. In darker light, the right pupil measured 4 mm and the left pupil measured 5 mm. Both pupils were reactive to light. Funduscopy was not possible due to significant nystagmus. Left facial sensation was impaired. There was mild dysarthria. Motor examination was normal, there was no pronator drift and there were symmetrical reflexes with bilateral flexor plantar responses. Sensory examination revealed a left hemibody decrease in sharp touch and temperature