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Low dose Amantadine and Escitalopram combination in Atypical Parkinsonian disorders- A Retrospective chart review

Published online by Cambridge University Press:  19 July 2023

S. M. Tripathi  and
P. Chutia
S. M. Tripathi*
Affiliation:
Department of Geriatric Mental Health, King George’s Medical University, Lucknow, India
P. Chutia
Affiliation:
Department of Geriatric Mental Health, King George’s Medical University, Lucknow, India
*
*Corresponding author.

Abstract

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Introduction

The response to conventional antiparkinsonian medications is elusive in atypical parkinsonian disorders. Improvement in parkinsonian symptoms in atypical parkinsonian disorders has been reported with anecdotal use of Amantadine. The role of serotonergic control over the nigrostriatal pathway led to the use of Escitalopram.

Objectives

To examine the efficacy of low dose Amantadine and Escitalopram combination treatment in atypical parkinsonian disorder

Methods

A retrospective chart review of Atypical Parkinsonian disorder patients who received the combination of low dose Amantadine and Escitalopram and had follow up assessment available for a minimum of four months were studied. The primary outcome measure was change in Progressive Supranuclear Palsy rating scale, Unified Multiple System Atrophy rating scale score and Clinical Global Improvement Scale Change score in follow up visits.

Results

A total of 8 patients with a mean age of 68.5 years, 6 with a diagnosis of Progressive Supranuclear Palsy(PSP) and 2 with a diagnosis of Multiple System Atrophy(MSA) met the selection criteria for the study. Patients were treated with the dose of Amantadine 50mg twice daily and Escitalopram 5mg once daily. The symptom domain to respond first was autonomic symptoms followed by gait, mentation, limb and bulbar symptoms. Amantadine has unique dopaminergic and NMDA antagonist properties. Serotonin has a role in modulation of the autonomic functions and nigrostriatal circuitry. Thus, combining Escitalopram with Amantadine can help ameliorate the array of symptoms in atypical parkinsonian disorders.

Conclusions

The PSP and MSA patients responded to the combination of low dose Amantadine and Escitalopram as evidenced by objective rating scales and subjective clinician assessment. Further prospective trials for longer duration are needed to establish the effect size and stability of response.

KEYWORDS: steele richardson olszewski disease, shy dragger syndrome, antidepressants

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S235 - S236
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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