This protocol targets patients with the parkinsonian type of multiple system atrophy (MSA-P) who present with the characteristic motor constellation of parkinsonism: bradykinesia combined with resting tremor, rigidity, or both, with or without postural instability.
Parkinsonism is the defining motor feature of MSA-P. Bradykinesia is the obligatory core finding, accompanied by at least one of resting tremor or rigidity. Postural instability may also be present. This clinical picture sets the stage for a distinct treatment consideration compared with idiopathic Parkinson disease.
For MSA-P patients experiencing certain specific motor symptoms—including dyskinesia, dystonia, and tremor—a particular pharmacological agent may be considered, especially in those who show limited or absent response to a standard dopaminergic approach. The treatment carries a recognised side-effect profile that warrants clinical vigilance.
DOI: 10.1212/cont.0000000000001598
Parkinsonism is the major motor constellation of the parkinsonian type of multiple system atrophy, which consists of bradykinesia, with either resting tremor or rigidity or both, with or without postural instability.
Amantadine can be tried in patients experiencing dyskinesia, dystonia, and tremor (although mostly polyminimyoclonus) in the setting of multiple system atrophy, as in patients with Parkinson disease and in those who have no response to levodopa, but clinicians must be aware of its potential side effects, including ankle edema, livedo reticularis, urinary retention, constipation, dry mouth, blurred vision, cognitive impairment, and hallucinations.
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