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Neurological Rehabilitation

Rehabilitation of Chimeric Antigen Receptor T Cell Associated Parkinsonism: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 6

    Primary Author(s)

  • Kira Kopacz, MD

    Resident
    Mayo Clinic College of Medicine & Science (Rochester) PM&R Program
    Rochester, Minnesota

    • Poster Presenter(s)

  • Corbrielle Boulard, MD (she/her/hers)

    Resident
    Mayo Clinic College of Medicine & Science (Rochester) PM&R Program
    Rochester, Minnesota

    • Co-Author(s)

  • RR

    Ronald K. Reeves, MD

    Associate Professor of PM&R
    Mayo Clinic of Rochester
    Rochester, Minnesota

Disclosure(s):
Kira Kopacz, MD: No financial relationships to disclose
Corbrielle Boulard, MD: No financial relationships to disclose
Case Diagnosis: Chimeric antigen receptor T cell (CAR-T) associated parkinsonism

Case Description or Program Description: CAR-T therapy is an effective treatment for refractory malignancies, but can cause severe neurological complications, including confusion, hypokinetic movements, and seizures. The patient presented to an inpatient rehabilitation unit with new onset parkinsonism after CAR-T for the treatment of multiple myeloma. She presented one month after symptom onset which included bradykinesia, postural instability, hypophonia, and tremor. Prior to rehab, she was prescribed propranolol, which slightly improved her tremor. Due to symptom severity, initial participation in her plan of care was severely limited. Neurology recommended a trial of low-dose carbidopa-levodopa alongside propranolol. With this regimen, the patient showed minor tremor improvement and functional gains. However, increasing the carbidopa-levodopa dosage led to anxiety, jitteriness, and worsening tremors, prompting a return to the original dose. Over the course of her rehabilitation, she improved from maximum assistance to minimal-moderate assistance with activities of daily living (ADLs) and achieved minimal assistance for transfers and mobility with a front-wheeled walker. At her 3 month follow up, the patient continued propranolol and carbidopa-levodopa with overall improvement of her mobility and facial expressions.

Setting: Inpatient rehabilitation unit in an academic institution

Assessment/Results: Initially, the patient’s severe symptoms hindered her rehabilitation. However, the introduction of low-dose carbidopa-levodopa led to functional improvement, though side effects were noted with dosage escalation.

Discussion (relevance): CAR-T-related neurotoxicity, including parkinsonism, represents a challenge in patient management. PM&R physicians should be prepared to address these complications to optimize rehabilitation outcomes.

Conclusions: Inpatient rehabilitation, paired with carbidopa-levodopa treatment, can facilitate functional improvements in patients with CAR-T-associated parkinsonism.