Objective: This single case report of levodopa-responsive parkinsonism, caused by an accidental systemic contamination with 10 microgram lipopolysaccharides (LPS) from Salmonella minnesota, describes the treatment options with the glucocorticoid methylprednisolone, the anticonvulsant sodium valproate and the antibiotic ofloxacin, which are usually not effective in cases of idiopathic PD.

Background: One intranigral or systemic injection of LPS in mice induces an inflammation driven degeneration of the dopaminergic neurons in the substantia nigra. Dexamethasone is able to prevent this neurodegeneration (Herrera et al., J Neurochem 2002; 81:150-7). The histone deacetylase inhibitor valproic acid reduces LPS-caused dopaminergic neurotoxicity in rat neuron-glia cultures (Hong et al., Neuroscience 2007; 149(1):203-12). The fluoroquinolone ofloxacin binds to LPS.

Methods: Symptoms of parkinsonism and the LPS-induced inflammation (6.6 ng LPS/ml cerebrospinal fluid) were treated with oral daily doses of 20-40 mg methylprednisolone for 7 days several times, with 200 mg ofloxacin for 5 days at a time and with 1500 mg sodium valproate daily.

Results: In 1995 first symptoms of parkinsonism occurred in a 22 yrs old female 21 days after a contamination with LPS with sepsis-like symptoms. The diagnosis of PD was confirmed by neurological examinations, levodopa tests and a positron emission tomography with (18)F-DOPA in 2001. Methylprednisolone causes a rapid decreasing rigidity, a reduced bradykinesia, less myalgia and neuralgia, an improved sleeping quality and less muscle weakness with a prolongation of walking distance. Methylprednisolone is able to stop an acute LPS-induced inflammation of the CNS marked by a sudden deterioration of symptoms of parkinsonism leading to an akinetic crisis in the worst case. Ofloxacin reduces the rigidity especially of the neck and the respiratory muscles, improves the seeing of contrasts and is muscle relaxing in general. Sodium valproate induces a decline of rigidity particular of the neck. It often prevents LPS-caused acute inflammatory phases.

Conclusions: In this case report, the non-detoxified LPS provokes a chronic sometimes acute systemic and neuronal inflammation with parkinsonism. This is one of the rare cases, besides multiple sclerosis caused PD, with efficacy of methylprednisolone on symptoms of parkinsonism. Ofloxacin reduces the LPS-caused inflammation by binding to LPS. Sodium valproate has anti-inflammatory effects.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treatment-of-lipopolysaccharide-induced-parkinsonism/