Cerrahpasa Faculty of Medicine Data Bank: The Evaluation of Motor Complications in 555 Parkinson's Patients on levodopa Therapy

Abstract

Scientific Background: Although levodopa (LD) is still the gold-standard therapy in the treatment of Parkinson's disease (PD), its chronic use leads to motor complications such as wearing-off phenomenon (WO), and dyskinesia (DK) in almost all patients. Objectives: We aimed to assess the presence of motor complications in PD patients on LD therapy admitted to our out-patient clinic for over than 10 years, and the probable factors that could have influence their occurrence.
Material and Method In this retrospective study, among 647 PD patients admitted to our Movement Disorders Unit between January 1990 to July 2001, 555 patients who were on LD were grouped into two category according to the development of motor complications either WO or DK. The parameters assessed were as follows: the age at onset of the first symptom; duration of disease; the interval between the first symptom and the appearance of WO or DK; elapsed time between the first symptom and the initiation of LD; the initial dose of LD, duration of LD use; interval between initiation of LD therapy and the development of WO/DK; interval between first symptom and the initiation of a dopamine agonist (DA); the Hoehn &Yahr (H&Y) stages, and the Unified Parkinson's Disease Rating Scale (UPDRS) scores at the last available visit.
Results: Of 555 patients included in to the study, WO was present in 257 patients (46.3%), and DK in 167 (30. 7%). While 52% of patients with WO had also DK, only 10% of patients without WO had DK (p<0.001). The mean ages at onset of symptom between WO(+) and DK(+) groups were significantly earlier in compared to WO(-) and DK(-) groups (64 vs. 67 years, and 65 vs. 67 years, respectively; p<0.001). The duration of PD was longer in WO(+) and DK(+) groups (9 vs. 4 years, and 10 vs. 5 years, respectively; p<0.0001 ). The elapsed time between the first symptom and the occurrence of WO or DK; and elapsed time between first symptom and the initiation of LD did not differ between groups. The initial dose of LD was significantly higher in WO(+) and DK(+) groups (300 vs. 232 mg/d, and 292 vs. 251 mg/d, respectively; p=0.001). The elapsed time until the initiation of a DA was longer in WO(+) and DK(+) groups in compared to the groups without complications (p=0.001). The difference between the development of motor complications and H&Y stages were significant in both groups (p<0.007 in WO group, and p=0.002 in DK group). The UPDRS scores at the last available visit was higher in WO(+) and DK(+) groups than those of other groups (36 vs. 27, p<0.007; and 34 vs. 30, p=0.02; respectively). Conclusions: In this hospital-based study, we observed that the earlier onset of the first symptom, longer disease duration, advanced stage of disease, higher initial dose of LD, longer usage of LD, and late initiation of DA were found to be determining factors for the development of motor complications in PD. The elapsed time from the first symptom to the initiation of levodopa was not different in patients with or without motor complications.