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Motor fluctuations due to interaction between dietary protein and levodopa in Parkinson's disease.

Abstract

BACKGROUND

The modulation of levodopa transport across the blood brain barrier by large neutral amino acids is well documented. Protein limitation and protein redistribution diets may improve motor fluctuations in patients with Parkinson's disease but the pharmacokinetics and pharmacodynamics of levodopa and amino acids are highly variable.

METHODS

Clinical records of 1037 Parkinson's disease patients were analyzed to determine the proportion of patients with motor fluctuations related to protein interaction with levodopa. Motor fluctuations due to protein interaction with levodopa were defined as dietary protein being associated with (i) longer time to levodopa effectiveness, (ii) reduced benefit or duration of benefit, (iii) dose failures or (iv) earlier wearing off from a previously effective dose. Dose failures, sudden, painful or behavioral wearing-off periods, gait freezing, nausea, hallucinations, orthostasis, and dyskinesias were taken as markers of motor fluctuations, disease severity, and levodopa side effects potentially influenced by protein.

RESULTS

5.9 % of Parkinson's disease patients on levodopa, and 12.4 % with motor fluctuations on levodopa correlated their fluctuations with the relative timing of levodopa and protein intake. These patients were younger at disease onset, had worse motor fluctuations and had a higher incidence of family members with Parkinson's disease. Early wearing off or decreased dose efficacy were most commonly associated with protein interaction. 60 % of patients who modified their diets had weight loss.

CONCLUSIONS

This study suggests that clinically significant protein interaction with levodopa may occur mostly in a subset of Parkinson's disease patients with earlier disease onset and those with familial disease.

Links

Authors+Show Affiliations

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Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Current addresses: University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR 72205 USA.

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Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Healthcare Partners, 3565 Del Amo Blvd., Ste 200, Torrance, CA 90503 USA.

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Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA.

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Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA.

Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Mt. Sinai School of Medicine, Box 1637, New York, NY 10029 USA.

Source

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27231577

Citation

TY - JOUR T1 - Motor fluctuations due to interaction between dietary protein and levodopa in Parkinson's disease. AU - Virmani,Tuhin, AU - Tazan,Sirinan, AU - Mazzoni,Pietro, AU - Ford,Blair, AU - Greene,Paul E, Y1 - 2016/05/26/ PY - 2016///ecollection PY - 2016/2/10/received PY - 2016/5/10/accepted PY - 2016/5/26/epublish PY - 2016/5/28/entrez KW - Levodopa KW - Motor fluctuations KW - Parkinson disease KW - Protein effect SP - 8 EP - 8 JF - Journal of clinical movement disorders JO - J Clin Mov Disord VL - 3 N2 - BACKGROUND: The modulation of levodopa transport across the blood brain barrier by large neutral amino acids is well documented. Protein limitation and protein redistribution diets may improve motor fluctuations in patients with Parkinson's disease but the pharmacokinetics and pharmacodynamics of levodopa and amino acids are highly variable. METHODS: Clinical records of 1037 Parkinson's disease patients were analyzed to determine the proportion of patients with motor fluctuations related to protein interaction with levodopa. Motor fluctuations due to protein interaction with levodopa were defined as dietary protein being associated with (i) longer time to levodopa effectiveness, (ii) reduced benefit or duration of benefit, (iii) dose failures or (iv) earlier wearing off from a previously effective dose. Dose failures, sudden, painful or behavioral wearing-off periods, gait freezing, nausea, hallucinations, orthostasis, and dyskinesias were taken as markers of motor fluctuations, disease severity, and levodopa side effects potentially influenced by protein. RESULTS: 5.9 % of Parkinson's disease patients on levodopa, and 12.4 % with motor fluctuations on levodopa correlated their fluctuations with the relative timing of levodopa and protein intake. These patients were younger at disease onset, had worse motor fluctuations and had a higher incidence of family members with Parkinson's disease. Early wearing off or decreased dose efficacy were most commonly associated with protein interaction. 60 % of patients who modified their diets had weight loss. CONCLUSIONS: This study suggests that clinically significant protein interaction with levodopa may occur mostly in a subset of Parkinson's disease patients with earlier disease onset and those with familial disease. SN - 2054-7072 UR - https://www.unboundmedicine.com/medline/citation/27231577/full_citation ER -