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To the Editor: 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 trihexy-phenidyl 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...

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