Background: Rotigotine is a novel non-ergot dopamine agonist, with effects on the biogenic amine neurotransmissions. For this reason we have used transdermal rotigotine in three congenital disorders of these neurotransmitters: Aromatic L-Aminoacid decarboxylase (AADC) deficiency (OMIM # 608643), Tyrosine hydroxilase (TH) deficiency (OMIM # 191290) and Dopamine transporter (DT) deficiency (OMIM # 126455). Case Report: In a 11 years old boy with AADC the replacement of pergolide with transdermal rotigotine resulted in an improvement of trunkal stability, head control and motor planning. A faster and more autonomous walking without support, a faster execution of motor tasks and an increase of muscular strength were observed. A similar improvement was also observed in a 15 years old male with TH deficiency. In this case the benefits were transitory and after some weeks a severe bradykinesia was observed. The discontinuation of rotigotine and its replacement with levo-dopa removed this last side effect. In a 4 years, 7 months old boy with a DT deficiency no clinical effects were obtained while bradykinesia , somnolence and asthenia. Conclusions: our experience suggests that transdermal rotigotine is a promising treatment in the therapeutic management of AADC deficiency. No results have been obtained in TH and DT deficiency
