Premium
Longitudinal study of the motor response to levodopa in Parkinson's disease
Author(s) -
Clissold Benjamin G.,
McColl Craig D.,
Reardon Katrina R.,
Shiff Mark,
Kempster Peter A.
Publication year - 2006
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/mds.21126
Subject(s) - levodopa , parkinson's disease , physical medicine and rehabilitation , motor function , cohort , psychology , dementia , medicine , gait , longitudinal study , movement disorders , disease , pediatrics , physical therapy , pathology
In this prospective study of 34 patients with Parkinson's disease, measurements of the short duration levodopa motor response have been performed in defined off states at 3 yearly intervals over a mean period of 11.4 years from the point of commencement of levodopa treatment. Twenty‐two patients were still available for study; 10 had died and 2 were lost to follow‐up. The levodopa motor response amplitude increases over the first 5 years of treatment, and thereafter, on and off scores worsen in parallel with conservation of the response. Patients who developed motor fluctuations within the first 5 years of treatment had, on average, a stronger response to levodopa with significantly better on phase motor function ( P = 0.003). Although the proportion of “midline” motor disability (affecting gait, balance, and cranial motor function) increases with time, these deficits do not actually become unresponsive to levodopa. Patients who developed dementia had a significantly more rapid decline in motor function. The latest graph of serial scores for the whole cohort shows an upward curving or exponential increase in motor disability after the first decade of treatment. Applying a notional untreated disability line to this graph—an estimate of the disability that would have accrued if drugs had never been given—we suggest that the long‐duration response to levodopa eventually runs down with disease progression. © 2006 Movement Disorder Society