A patient with probable multiple-system atrophy has had only 62.5 mg co-careldopa three times daily for two weeks and is labelled “levodopa

Question

A patient with probable multiple-system atrophy has had only 62.5 mg co-careldopa three times daily for two weeks and is labelled “levodopa unresponsive”. There is no limiting hypotension, psychosis or dyskinesia. Which interpretation is most accurate?

Accepted Answer

Trial inadequate; titrate towards 1 g levodopa daily and assess over at least one month

Answer

Any response at 250 mg four times daily would exclude MSA and establish Parkinson disease

Answer

The trial is adequate; response at 62.5 mg three times daily should emerge within two weeks

Answer

An acute subcutaneous apomorphine challenge after stopping levodopa is required to judge responsiveness

Answer

A dopamine agonist trial for one month must replace levodopa before responsiveness is judged

MOGAD – Relapsing — SCE Neurology MCQ

A patient with probable multiple-system atrophy has had only 62.5 mg co-careldopa three times daily for two weeks and is labelled “levodopa unresponsive”. There is no limiting hypotension, psychosis or dyskinesia. Which interpretation is most accurate?