Amelioration of frozen gait by tandospirone, a serotonin 1A agonist, in a patient with pure akinesia developing resistance to L-threo-3,4-dihydroxyphenylserine

Clin Neuropharmacol. Jul-Aug 2001;24(4):232-4. doi: 10.1097/00002826-200107000-00007.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aldehyde-Lyases / therapeutic use*
  • Basal Ganglia Diseases / drug therapy
  • Basal Ganglia Diseases / metabolism
  • Droxidopa / therapeutic use*
  • Drug Resistance
  • Drug Therapy, Combination
  • Female
  • Gait Disorders, Neurologic / drug therapy*
  • Gait Disorders, Neurologic / metabolism
  • Humans
  • Isoindoles
  • Piperazines / therapeutic use*
  • Pyrimidines / therapeutic use*
  • Receptors, Serotonin* / metabolism
  • Receptors, Serotonin, 5-HT1
  • Serotonin Receptor Agonists / therapeutic use*

Substances

  • Isoindoles
  • Piperazines
  • Pyrimidines
  • Receptors, Serotonin
  • Receptors, Serotonin, 5-HT1
  • Serotonin Receptor Agonists
  • tandospirone
  • 3,4-dihydroxyphenylserine aldolase
  • Aldehyde-Lyases
  • Droxidopa