Case Report: Sublingual Levodopa in Advanced Multiple System Atrophy

Multiple System Atrophy is a progressive neurodegenerative disorder characterized by parkinsonism and autonomic dysfunction. Dysphagia and gastric dysmotility in advanced disease often compromise enteral medication absorption, limiting the effectiveness of standard oral or PEG-administered levodopa. We report a case of advanced MSA in which sublingual administration of co-beneldopa provided rapid and reliable relief from severe motor "off" episodes when enteral therapy failed. This novel approach bypassed gastrointestinal absorption, improved symptom control, and enhanced patient comfort in a palliative setting. Further research is warranted to evaluate the efficacy and safety of sublingual levodopa in similar contexts.