Recovery in non-vascular locked-in syndrome during treatment with Sinemet

A case of successful pharmacological therapy of non-vascular locked-in syndrome (LIS) is described. A 22-year-old male experienced aqueductal stenosis following an episode of viral meningitis 11 months prior to admission. A ventriculo-peritoneal shunt was inserted and subsequently revised three times. Following the last procedure, the patient remained mute, quadriplegic and aphagic. There was no change in the patient's status for 9 days. Bromocriptine (2.5 mg daily) was begun and increased to 45 mg daily without any change in PECS scores. It was then tapered and Sinemet (75/300 daily) was begun and increased to 75/750 daily. The PECS scores in all areas rose steadily during the subsequent 6 weeks. Sinemet may be of value in the rehabilitation therapy of non-vascular LIS; serial patient evaluation by a PECS system may facilitate assessment of the response.