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

Background: Progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are less responsive to usual antiparkinsonian drugs. Purpose: To assess the treatment outcome of the combination of low-dose amantadine and escitalopram in the study population. Methods: 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. Results: 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. Conclusion: 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.