Table 1.

Clinical characteristics of two patients with Parkinson’s disease who had severe coldness of the lower limbs.

Characteristics	Patient 1	Patient 2
Age/sex	75/M	80/F
Disease duration, years	4	10.7
Hoehn-Yahr stage	4	3 (on periods) 4 (off periods)
Clinical phenotype	Akinesia	Akinesia
Wearing-off	+	+
Hallucinations	+	-
Dyskinesia	-	-
MMSE during cold limbs	27 *a	27
Autonomic symptoms	C, OD, S	C, U
Nature of the cold limbs
Duration	NA	2.4 yr
Time	Everyday, off periods	Everyday, off periods
Presence during summer time	+	+
Regions	Both proximal and distal LL	Both distal LL
With pain	Frequent	Often
Other sensory symptoms	Tightness	Tightness
Decreased by physical warm stimulations	+	+
Daily treatment on development of cold limbs (dose/day)
Levodopa	500 mg	300 mg
Pergolide	-	0.5 mg
Selegiline	7.5 mg	-
Entacapone	-	600 mg
Zonisamide	50 mg	-
Dose modification within 12 months before cold limbs (time)	ZNS initiated (25 mg/d) and increased (50 mg/d)	Entacapone increased (600 mg/d) 6 months
Neuroleptics	-	-
Pain medication	Pregabalin (150 mg/d)	Poultice
Treatment
Antiparkinsonian drugs	Rotigotine initiated and increased (36 mg/d)	RP initiated and increased (8 mg/d); rotigotine initiated and increased (18 mg/d)
Neuroleptics	-	-
Outcome
UPDRS Part 3	21	11
Hoehn-Yahr stage	3 (on periods) 3 (off periods)	3 (on periods) 4 (off periods)
Cold limbs	Mildly reduced	Mildly reduced
Pain	Mildly reduced	Disappeared

PD, Parkinson's disease; Hs, hallucinations; UPDRS, Unified Parkinson's Disease Rating Scale; LL, lower limbs; MMSE, Mini-Mental State Examination; C, constipation; U, urinary urgency; OD, orthostatic diziness; S, sweating abnormalities; m, months; d, day; ND, not done.

*a: examinated in September 2014 when cold limbs were present.