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Evolution of motor fluctuations in Parkinson's disease: A longitudinal study over 6 years
Author(s) -
Reardon Katrina A.,
Shiff Mark,
Kempster Peter A.
Publication year - 1999
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/1531-8257(199907)14:4<605::aid-mds1009>3.0.co;2-h
Subject(s) - dyskinesia , parkinson's disease , dopaminergic , levodopa , disease , medicine , degenerative disease , central nervous system disease , longitudinal study , gait , physical medicine and rehabilitation , psychology , neuroscience , dopamine , pathology
A prospective longitudinal 6‐year study of 34 patients with Parkinson's disease from the time of initiation of drug treatment explored changes in the motor response to L ‐dopa over the early to mid disease course. Motor fluctuations developed in 41% after a mean L ‐dopa treatment interval of 25 months and dyskinesia developed in 53% after a mean of 15 months' treatment. Patients who developed fluctuations had a significantly better response to L ‐dopa than nonfluctuators. Nonfluctuators also had significantly greater “midline” motor disability affecting cranial and truncal muscles and gait. The development of motor fluctuations may simply reflect a retained capacity to respond to L ‐dopa as endogenous dopaminergic neurotransmission declines with progressive nigral cell loss. Many patients who show no sign of motor fluctuation 5 or 6 years into the disease course have a relatively blunted response to L ‐dopa. The proportion of such cases seems to correspond to the percentage that have coexisting striatal pathologic changes in postmortem studies.