Southern Medical Journal:
June 2007 - Volume 100 - Issue 6 - p 617
Special Sections: Letters to the Editor
Successful Treatment of Parkinson Disease with Memantine
Alisky, Joseph Martin MD, PhD
Free AccessArticle Outline
Author InformationMarshfield Clinic Research Foundation; Marshfield, WI; Marshfield Clinic Thorp Center; Thorp, WI
Memantine, a noncompetitive N-methyl-D-aspartate glutamate receptor inhibitor currently indicated for treatment of moderate Alzheimer disease, was originally developed for Parkinson disease and is still widely prescribed in Europe as an anti-Parkinsonian agent.1-3 Derived from the older drug amantadine, memantine dampens output from the subthalamic nucleus, potentiates dopamine release and attenuates degeneration of dopaminergic neurons.2-4 A case history presented here illustrates how memantine might have a productive therapeutic niche in the United States for Parkinson disease.
A 78-year-old woman with idiopathic Parkinson disease diagnosed one year before had mild cogwheel rigidity worse on the left side and intermittent pill-rolling tremors mainly in the left hand. She could do all basic activities of daily living and had no apparent functional limitations but was requesting treatment because her symptoms slowed her down. She had previously been tried on l-dopa/carbidopa but had developed unacceptable nausea and dizziness even from a starting dose. An anticholinergic agent such as trihexyphenidyl was considered, but she was already taking oxybutynin for overactive bladder and was adamant about not taking anything else that might worsen her memory. Therefore, she was prescribed a memantine titration pack, 5 mg daily and increased over a month to 10 mg twice daily. At her one-month follow-up, she reported improvement in initiation of activity, with no side effects of any kind. Physical examination confirmed that she had no visible tremor and almost complete abatement of the left-sided rigidity. She has been maintained on memantine 10 mg twice daily for the past year and continues to be satisfied with the medication.
Undoubtedly, memantine could be used for Parkinson disease both as monotherapy and as an adjunct to a multidrug regimen. In primary care practice, patients could be tried on the starter packs, and formal clinical trials would be easy to conduct as well. Ultimately, approval from the United States Food and Drug Administration (FDA) could be sought. Currently, the only FDA approved use for memantine is for Alzheimer disease, but other off-label uses besides Parkinson disease include vascular dementia, spasticity and neurogenic bladder.5 American physicians and researchers should give memantine for Parkinson disease some consideration, for new therapeutic options and improved outcomes.
Joseph Martin Alisky, MD, PhD
Marshfield Clinic Research Foundation(威斯康星州马什菲尔德诊所研究基金会）
Marshfield Clinic Thorp Center