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Levodopa effect and motor function in late stage Parkinson’s disease
Lund University.
Australien.
Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.ORCID iD: 0000-0003-2174-372X
Lund University.
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2017 (English)In: Movement Disorders, 2017, Vol. 32, p. 915-916Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Objective: To assess responsiveness to Levodopa (L-dopa) in patients with late stage Parkinson’s disease (PD). Moreover, to investigate if the L-dopa effect is stable or whether motor fluctuations and dyskinesias are present.

Background: A majority of PD patients treated with L-dopa develop motor complications, in many cases within a few years of treatment. It is unclear to which degree L-dopa remains effective also in the last stages and whether motor fluctuations and dyskinesias remain a problem.

Methods: The study included 30 patients with PD in Hoehn and Yahr (HY) stages IV and V in “on” and/or having a substantial need of help with ADL (<50% Schwab and England Scale) and having been diagnosed with PD for =7 years. Nineteen were men, median age 83 and median PD duration 12 years. Nineteen were in HY stage IV and 11 in V. L-dopa responsiveness was assessed with an L-dopa test and motor evaluation according to a standardized protocol in the defined “off” and defined “on” state. Motor performance was assessed by the Unified PD Rating Scale (UPDRS) III and timed tests for gait and hand-arm. The participants were further evaluated with a mobile movement-analyses-system, the Parkinson’s Kinetigraph (PKG) for 10 days.

Results: The number of participants with an improvement in UPDRS III during L-dopa test of =15% were 15 (50%) and of =30% were 6 (20%). The median UPDRS III score in “off” was 46 (q1-q3, 37-53) and in “on” 36 (28-46), with a median improvement of 15.5% (8-27%), p<0.001. There was a statistically significant effect in almost all variables; UPDRS III total score; speech (item 18); resting tremor (item 20); tremor (items 20, 21); rigidity (item 22); bradykinesia (items 23-26, 31); gait (item 29); axial signs (items 18, 19, 22, 27-30); dyskinesias (Clinical Dyskinesia Rating Scale); hand-arm movement; gait test and blood pressure. According to the UPDRS IV, 67% experienced predictable off-fluctuations, while 30% had unpredictable off-fluctuations. The prevalence of dyskinesias according to item 32 (duration of dyskinesias =1) of the UPDRS IV was 47%. According to the PKG registrations, some patients were experiencing significant motor fluctuations, though very few had significant dyskinesias.

Conclusions: Half of a group of patients with late stage PD (HY IV-V in “on”) had a significant L-dopa response (=15% on the UPDRS III). According to the UPDRS IV, a majority of the patients still had motor fluctuations and about half had dyskinesias.

Place, publisher, year, edition, pages
2017. Vol. 32, p. 915-916
Series
Movement Disorders, E-ISSN 1531-8257
National Category
Neurology
Identifiers
URN: urn:nbn:se:hkr:diva-18458OAI: oai:DiVA.org:hkr-18458DiVA, id: diva2:1237905
Conference
The 21st International Congress of Parkinson's Disease and Movement Disorders. Vancouver, Canada, 2017
Available from: 2018-08-10 Created: 2018-08-10 Last updated: 2018-11-06Bibliographically approved

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Hagell, Peter
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Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and EducationResearch Platform for Collaboration for HealthAvdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap
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CiteExportLink to record
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