Whenever Parkinsonism and Muscle Hyperexcitability, Think Calcium
Gonçalo Diniz de Pinho, MD,1,3*, Inês Brás Marques, MD1, Daniel Macedo, MD2,3, Ana Filipa Martins, MD2, Ana Calado, MD1,3
1Neurology Department, Hospital da Luz, Lisboa, Portugal.
2Endocrinology Department, Hospital da Luz, Lisboa, Portugal.
3Católica Medical School, Lisboa, Portugal.
*Corresponding Author: Gonçalo Diniz Pinho, Hospital da Luz, Lisboa, Avenida Lusíada, 100, 1500-650 Lisboa, Portugal. ORCID: 0009-0004-0671-0799
https://doi.org/10.58624/SVOANE.2026.07.006
Received: January 26, 2026
Published: February 17, 2026
Citation: de Pinho GD, Marques IB, Macedo D, Martins AF, Calado A. Whenever Parkinsonism and Muscle Hyperexcitability, Think Calcium. SVOA Neurology 2026, 7:1, 28-32. doi. 10.58624/SVOANE.2026.07.006
Abstract
Early-onset symmetric parkinsonism that is unresponsive to therapy should prompt exclusion of treatable causes. A 55-year-old patient presented with one-year-long akinetic parkinsonism and depression. Levodopa-carbidopa trials were unsuccessful. Later aggravation with weight loss, muscle spasms and chorea prompted secondary imaging and laboratory studies, which showed bilateral basal ganglia calcification and primary hypoparathyroidism with low plasmatic calcium. Their extrapyramidal symptoms and muscle hyperexcitability were successfully treated with a parathyroid hormone receptor agonist.
Keywords: Secondary Parkinsonism, Spasms, Fahr, Hypoparathyroidism, Hypocalcemia
