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Levodopa effect and motor function in late stage Parkinson's disease

Rosqvist, Kristina LU ; Horne, Malcolm; Hagell, Peter LU ; Iwarsson, Susanne LU ; Nilsson, Maria H. LU and Odin, Per LU (2018) In Journal of Parkinson's Disease 8(1). p.59-70
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... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Dyskinesias, Fluctuations, Late stage, Levodopa, Levodopa test, Motor complications, Parkinson's disease
in
Journal of Parkinson's Disease
volume
8
issue
1
pages
12 pages
publisher
IOS Press
external identifiers
  • scopus:85043596368
  • pmid:29480220
ISSN
1877-7171
DOI
10.3233/JPD-171181
language
English
LU publication?
yes
id
e580efa8-8be9-4a83-be75-124a7b45866a
date added to LUP
2018-03-27 10:36:49
date last changed
2019-08-18 04:47:41
@article{e580efa8-8be9-4a83-be75-124a7b45866a,
  abstract     = {<p>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.</p>},
  author       = {Rosqvist, Kristina and Horne, Malcolm and Hagell, Peter and Iwarsson, Susanne and Nilsson, Maria H. and Odin, Per},
  issn         = {1877-7171},
  keyword      = {Dyskinesias,Fluctuations,Late stage,Levodopa,Levodopa test,Motor complications,Parkinson's disease},
  language     = {eng},
  number       = {1},
  pages        = {59--70},
  publisher    = {IOS Press},
  series       = {Journal of Parkinson's Disease},
  title        = {Levodopa effect and motor function in late stage Parkinson's disease},
  url          = {http://dx.doi.org/10.3233/JPD-171181},
  volume       = {8},
  year         = {2018},
}