Amelioration of frozen gait by tandospirone, a serotonin 1A agonist, in a patient with pure akinesia developing resistance to L-threo-3,4-dihydroxyphenylserine.
A 71-year-old woman presented with severe akinesia, frozen gait, and compromised postural reflexes, without rigidity, tremor, or vertical gaze disturbance. With a working diagnosis of pure akinesia, we administered amantadine (150 mg/d) and L-threo-3,4-dihydroxyphenylserine (DOPS) (600 mg/d), which alleviated her symptoms. When frozen gait recurred 2 months later, we increased the dose of L-threo-DOPS to 900 mg/d and added levodopa (300 mg/d) combined with carbidopa, but this failed to improve the patient's symptoms. We then combined administration of tandospirone, a serotonin (5-HT) 1A agonist with L-threo-DOPS (600 mg/d), resulting in marked clinical improvement. Tandospirone is reported to activate noradrenergic neurons via the 5-HT 1A receptor, which could account for such striking improvement in a patient previously responsive to the noradrenergic precursor L-threo-DOPS given alone.
Miyata
S
S
Department of Neuropsychiatry, Okayama University Medical School, Okayama, Japan.
Hamamura
T
T
Yoshinaga
J
J
Nakamura
Y
Y
Imamura
T
T
Hikiji
A
A
Kuroda
S
S
D000368:Aged; D000446:Aldehyde-Lyases / Q000627:therapeutic use*; D001480:Basal Ganglia Diseases / Q000188:drug therapy / Q000378:metabolism; D015103:Droxidopa / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D054833:Isoindoles; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D011985:Receptors, Serotonin / Q000378:metabolism; D044263:Receptors, Serotonin, 5-HT1; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*
D054833:Isoindoles; D010879:Piperazines; D011743:Pyrimidines; D011985:Receptors, Serotonin; D044263:Receptors, Serotonin, 5-HT1; D017366:Serotonin Receptor Agonists; C055267:tandospirone; C051902:3,4-dihydroxyphenylserine aldolase; D000446:Aldehyde-Lyases; D015103:Droxidopa