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l-DOPS therapy for refractory orthostatic hypotension in autoimmune autonomic neuropathy

From Beth Israel Deaconess Medical Center, Boston, MA.

Address correspondence and reprint requests to Dr. Roy Freeman, Autonomic and Peripheral Nerve Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215; e-mail: rfreeman{at}bidmc.harvard.edu

The authors report a 46-year-old woman with antibodies to the nicotinic acetylcholine receptor (NiAchR) of the autonomic ganglia. She presented with severe orthostatic intolerance refractory to treatment with midodrine, fludrocortisone, erythropoietin, vasopressin, salt, and fluid loading. Addition of l-threo-3,4-dihidroxyphenylserine (l-DOPS) substantially improved blood pressure and orthostatic tolerance. l-DOPS may benefit patients with severe orthostatic intolerance and be particularly effective in patients with ganglionic NiAchR antibodies.

Disclosure: The authors report no conflicts of interest.

Received February 17, 2005. Accepted in final form June 7, 2005.

This article has been cited by other articles:

				C. H. Gibbons, S. A. Vernino, and R. Freeman Combined Immunomodulatory Therapy in Autoimmune Autonomic Ganglionopathy Arch Neurol, February 1, 2008; 65(2): 213 - 217. [Abstract] [Full Text] [PDF]

				Z. Wang, P. A. Low, J. Jordan, R. Freeman, C. H. Gibbons, C. Schroeder, P. Sandroni, and S. Vernino Autoimmune autonomic ganglionopathy: IgG effects on ganglionic acetylcholine receptor current Neurology, May 29, 2007; 68(22): 1917 - 1921. [Abstract] [Full Text] [PDF]