Effects of Rivastigmine on Patients with Spinocerebellar Ataxia Type 3: A Case Series of Five Patients

Background: Rivastigmine is an acetylcholine esterase inhibitor which is commonly used as therapy for dementia in Alzheimer's disease and Parkinson's disease (PD). Recently, a randomized controlled trial demonstrated a positive effect of rivastigmine on gait function in nondemented PD patients. Disturbed gait is a shared hallmark of PD and ataxias. Objectives: We hypothesized that the effect of rivastigmine could be translated to spinocerebellar ataxia (SCA) improving gait function. Method: Five patients with SCA type 3 were treated with transdermal rivastigmine for 8 weeks. The patients were monitored using the Scale for the Assessment and Rating of Ataxia (SARA) and an electronic walkway system (GAITRite (R)). Results: Gait function was not changed by treatment, but 4 patients who continued treatment for 8 weeks showed improved coordination of extremities. The SARA sum score, which was 7.6 +/- 2.2 at baseline, had dropped by 1.5 +/- 1.9 after 4 weeks and by 2.1 +/- 1.4 after 8 weeks. Conclusions: Contrary to our hypothesis, we observed no improvement of gait parameters as assessed by SARA and GAIT-Rite (R), but coordination abilities were improved. Rivastigmine was well tolerated, but known side effects of rivastigmine, such as deterioration of asthma, may appear. Further trials in larger cohorts are needed to confirm our findings.