Session Information
Session Title: AA 2022 Posters - Pediatric Rehabilitation
Session Time: None. Available on demand.
Disclosures: Christi F. Ng, MD, MPH: No financial relationships or conflicts of interest
Background and/or Objectives: To describe the effects reported by caregivers of Rett individuals while taking carbidopa/levodopa. To provide clinicians expectations and a framework for prescribing carbidopa/levodopa. Rett individuals often exhibit one or more features of Parkinsonism, such as freezing, rigidity and/or instability. Such symptoms can impair function and the learning of new motor skills. At our multi-disciplinary Rett clinic, we have been prescribing carbidopa/levodopa, and to date there are no known publications describing the use of carbidopa/levodopa to symptomatically treat Parkinsonism in Rett.
Design: Single-arm, retrospective cohort study
Setting: Outpatient
Participants: 25 subjects with Rett and Parkinsonism
Interventions: Enteral administration of carbidopa/levodopa (1/1/2015 to 12/31/2021)
Main Outcome Measures: Caregiver reports of Parkinsonism and side effects
Results: Average age for a patient starting carbidopa/levodopa was 14 yo. Most common Parkinsonian features: freezing (n=22, 88%), masked facies (n=15, 60%) and rigidity/stiffness (n=12, 48%). Twenty (75%) participants with a reduction of Parkinsonism while on carbidopa/levodopa. Nf3 (12%) who discontinued the medication because there were no perceived benefits. Nf2 (8%) who stopped the medication because it caused side effects, in addition to the lack of improvement. Side effects were common; eighteen (72%) patients had one or more side effects. Most common side effects: constipation (n=9, 36%), reflux/vomiting (n=11, 44%) and/or abdominal cramping/bloating (n=3, 12%). Other less common side effects: changes in mood/agitation, sedation, and hair loss.
Conclusions: Carbidopa/levodopa is a safe and generally well tolerated medication used to reduce Parkinsonian features exhibited by Rett patients. Improvements include more fluid gait, decreased freezing, increased engagement and increased proficiency of Augmentative & Alternative Communication devices. For most, parents felt comfortable managing side effects, such as constipation, in order to continue the benefits. Given the nature of the study design, only broad inferences may be made. However, this does offer insight and a reasonable treatment option for colleagues who may be observing similar features in their Rett patient population.
Level of Evidence: Level IV
To cite this abstract in AMA style:
Ng CF, Benke TA, Dinkel TM, McManus BM, Stratton AT. Reduction of Parkinsonian Features in Rett Patients While on Carbidopa/Levodopa [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/reduction-of-parkinsonian-features-in-rett-patients-while-on-carbidopa-levodopa/. Accessed September 7, 2024.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/reduction-of-parkinsonian-features-in-rett-patients-while-on-carbidopa-levodopa/