Fanciulli and Wenning's review (Jan. 15 issue) on multiple-system atrophy is comprehensive and up to date. In it, the authors state that the open-label administration of gabapentin could ameliorate cerebellar symptoms in single cases of this disease. However, the cited reference describes a noticeable improvement in gait in one patient who received a diagnosis of olivopontocerebellar atrophy (OPCA) after a single dose of 400 mg of gabapentin and alleviation of dysarthria and oscillopsia in another patient with OPCA during long-term therapy with gabapentin. These patients could not have received a diagnosis of multiple-system atrophy, since neither had features of autonomic dysfunction. In contrast, gabapentin was found to cause generalized weakness and to worsen gait and dysarthria in three patients with multiple-system atrophy, forcing withdrawal of the drug..
