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Levodopa Effect and Motor Function in Late Stage Parkinson's Disease.
J Parkinsons Dis. 2018; 8(1):59-70.JP

Abstract

BACKGROUND

It is unclear to which degree Levodopa (L-dopa) remains effective also in the late stage of Parkinson's disease (PD) and to which degree motor fluctuations and dyskinesias remain a problem.

OBJECTIVE

To assess responsiveness of motor symptomatology to L-dopa in a group of patients with late stage PD. Moreover, to investigate the extent to which motor fluctuations and dyskinesias occur.

METHODS

Thirty PD patients in Hoehn and Yahr (HY) stages IV and V in "on" were included. L-dopa responsiveness was assessed with a standardized L-dopa test in the defined "off" and defined "on" states. Motor function was assessed by the Unified PD Rating Scale (UPDRS) III and timed tests. Motor fluctuations and dyskinesias were assessed by the UPDRS IV. The participants were further monitored for 10 days with a mobile movement-analyses-system, the Parkinson's Kinetigraph (PKG). The median (q1-q3) L-dopa equivalent daily dose (LEDD) was 799 (536-973) mg.

RESULTS

The UPDRS III score improved with ≥15% in 15 (50%) and with ≥30% in six (20%) participants during the L-dopa test. The median (q1-q3) UPDRS III score in "off" was 46 (37-53) and in "on" 36 (28-46). Twenty-one (70%) of the participants reported either predictable or unpredictable "off" fluctuations (items 36-37). The prevalence of dyskinesias (item 32, duration of dyskinesias ≥1) was 47%. The PKG indicated that dyskinesias primarily were mild and that a majority had a pronounced "off" symptomatology, spending a large proportion of the day either asleep or very inactive.

CONCLUSIONS

Half of a group of patients with late stage PD had an L-dopa response of ≥15% on the UPDRS III. According to the UPDRS IV, a majority of the patients had motor fluctuations and about half had dyskinesias, although the PKG results suggested that these were not very severe.

Authors+Show Affiliations

Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, Lund, Sweden.Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia. Centre for Clinical Neurosciences and Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden.Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden. Memory Clinic, Skåne University Hospital, Malmö, Sweden.Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, Lund, Sweden. Department of Neurology, Skåne University Hospital, Lund, Sweden. Department of Neurology, Central Hospital, Bremerhaven, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29480220

Citation

Rosqvist, Kristina, et al. "Levodopa Effect and Motor Function in Late Stage Parkinson's Disease." Journal of Parkinson's Disease, vol. 8, no. 1, 2018, pp. 59-70.
Rosqvist K, Horne M, Hagell P, et al. Levodopa Effect and Motor Function in Late Stage Parkinson's Disease. J Parkinsons Dis. 2018;8(1):59-70.
Rosqvist, K., Horne, M., Hagell, P., Iwarsson, S., Nilsson, M. H., & Odin, P. (2018). Levodopa Effect and Motor Function in Late Stage Parkinson's Disease. Journal of Parkinson's Disease, 8(1), 59-70. https://doi.org/10.3233/JPD-171181
Rosqvist K, et al. Levodopa Effect and Motor Function in Late Stage Parkinson's Disease. J Parkinsons Dis. 2018;8(1):59-70. PubMed PMID: 29480220.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Levodopa Effect and Motor Function in Late Stage Parkinson's Disease. AU - Rosqvist,Kristina, AU - Horne,Malcolm, AU - Hagell,Peter, AU - Iwarsson,Susanne, AU - Nilsson,Maria H, AU - Odin,Per, PY - 2018/2/27/entrez PY - 2018/2/27/pubmed PY - 2019/10/30/medline KW - Parkinson’s disease KW - dyskinesias KW - fluctuations KW - late stage KW - levodopa KW - levodopa test KW - motor complications SP - 59 EP - 70 JF - Journal of Parkinson's disease JO - J Parkinsons Dis VL - 8 IS - 1 N2 - BACKGROUND: It is unclear to which degree Levodopa (L-dopa) remains effective also in the late stage of Parkinson's disease (PD) and to which degree motor fluctuations and dyskinesias remain a problem. OBJECTIVE: To assess responsiveness of motor symptomatology to L-dopa in a group of patients with late stage PD. Moreover, to investigate the extent to which motor fluctuations and dyskinesias occur. METHODS: Thirty PD patients in Hoehn and Yahr (HY) stages IV and V in "on" were included. L-dopa responsiveness was assessed with a standardized L-dopa test in the defined "off" and defined "on" states. Motor function was assessed by the Unified PD Rating Scale (UPDRS) III and timed tests. Motor fluctuations and dyskinesias were assessed by the UPDRS IV. The participants were further monitored for 10 days with a mobile movement-analyses-system, the Parkinson's Kinetigraph (PKG). The median (q1-q3) L-dopa equivalent daily dose (LEDD) was 799 (536-973) mg. RESULTS: The UPDRS III score improved with ≥15% in 15 (50%) and with ≥30% in six (20%) participants during the L-dopa test. The median (q1-q3) UPDRS III score in "off" was 46 (37-53) and in "on" 36 (28-46). Twenty-one (70%) of the participants reported either predictable or unpredictable "off" fluctuations (items 36-37). The prevalence of dyskinesias (item 32, duration of dyskinesias ≥1) was 47%. The PKG indicated that dyskinesias primarily were mild and that a majority had a pronounced "off" symptomatology, spending a large proportion of the day either asleep or very inactive. CONCLUSIONS: Half of a group of patients with late stage PD had an L-dopa response of ≥15% on the UPDRS III. According to the UPDRS IV, a majority of the patients had motor fluctuations and about half had dyskinesias, although the PKG results suggested that these were not very severe. SN - 1877-718X UR - https://www.unboundmedicine.com/medline/citation/29480220/Levodopa_Effect_and_Motor_Function_in_Late_Stage_Parkinson's_Disease_ L2 - https://content.iospress.com/openurl?genre=article&id=doi:10.3233/JPD-171181 DB - PRIME DP - Unbound Medicine ER -