Objective: To describe a case report on the use of Levodopa-carbidopa intestinal gel (LCIG) to treat non-motor symptoms in a patient with multiple system atrophy (MSA)

Background: There is no specific treatment for multiple systems atrophy (MSA-P), however, one of the commonly used symptomatic treatments is levodopa. Levodopa-carbidopa intestinal gel (LCIG) is an effective treatment in advanced PD and, although scarce, available data in MSA-P patients show that it can be a safe alternative to conventional formulations.

Method: Non-motor symptoms, namely respiratory, contribute significantly to the morbidity and mortality of patients with MSA-P, and may appear in the form of obstructive and/or central sleep apnea, dysrhythmia, dyspnea, hypoxemia and/or laryngeal stridor. The major gastric hypomotility presented in these patients further contributes to diminishing the benefit of levodopa.

We describe a 53-year-old man with MSA-P at a very advanced stage (10 years of evolution) who, throughout his illness, presented a partial response to levodopa, with motor fluctuations and, in 2021, started episodes of severe hypoxemia associated with severe stiffness of the lower limbs that appeared in OFF, especially at night. Given the impact on the patient’s quality of life, palliative treatment with LCIG was proposed.

Results: After starting the perfusion, which was chosen to be continuous throughout the 24 hours of the day, the episodes of hypoxemia did not recur and there was an improvement in dysautonomia, with a reduction in the episodes of orthostatic hypotension and a slight motor benefit.

Conclusion: Levodopa-carbidopa intestinal gel may be a therapeutic alternative to consider in MSA-P patients with motor fluctuations in response to levodopa.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-levodopa-carbidopa-intestinal-gel-to-treat-a-patient-with-multiple-system-atrophy-msa/