Low Dose Amantadine and Escitalopram in Progressive Supranuclear Palsy and Multiple System Atrophy

Progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are less responsive to usual antiparkinsonian drugs.

To assess the treatment outcome of the combination of low-dose amantadine and escitalopram in the study population.

A retrospective study of PSP and MSA patients from June 2021 to December 2022 treated with the dose of amantadine 100 mg and escitalopram 5 mg per day with a follow-up of 2 months at a tertiary care centre in India. The primary outcome measure was a change in the PSP and MSA severity rating scale scores, while cognition, neuropsychiatric symptoms and functionality scale scores were secondary outcomes on follow-up visits. Repeated measures ANOVA and Friedman rank test were used to analyse the data.

A total of 21 patients (8 PSP and 13 MSA), including 19 males, with a mean age of 72.84 years, were included. The mean total PSP rating scale score had a significant decline from baseline to week 2 and 8 (p < .001), along with the scores for limb symptoms (p < .001), ocular (p = .001), history (p = .003), gait (p = .007), mentation (p = .014) and bulbar (p = .018) symptoms. Similarly, the mean score of the MSA rating scale significantly decreased on follow-up visits (p < .001). The cognition, functional disability and behavioural symptoms scores also had significant improvement with p < .01.

The PSP and MSA patients had clinically significant improvement with the combination treatment in both motor and non-motor domains. Further prospective trials for longer durations are needed to establish the effect size and stability of response.