Do patients with late-stage Parkinson's disease still respond to levodopa?

Margherita Fabbri, Miguel Coelho, Daisy Abreu, Leonor Correia Guedes, Mario M. Rosa, Nilza Costa, Angelo Antonini, Joaquim J. Ferreira

Research output: Contribution to journalArticle

Abstract

Background: Late-stage Parkinson' disease (PD) is dominated by loss of autonomy due to motor and non-motor symptoms which can be marginally corrected by medications adjustments. However, controversy exists on the mechanisms underlying the apparent decrease of benefit from levodopa. Objective: To study the response to levodopa in late-stage PD (LSPD). Methods: 20 LSPD patients (Schwab and England ADL Scale 3 in MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (DBS) underwent an acute levodopa challenge test. MDS-UPDRS-III and the modified Abnormal Involuntary Movement Scale were evaluated in off and after administration of a supra-maximal levodopa dose. Results: LSPD patients had a median age of 78.8 (IQR: 73.5-82) and median disease duration of 14 years (IQR: 10-19.75). DBS patients had a median age of 66 (IQR: 61-72) and median disease duration of 18 years (IQR: 15-22). LSPD and DBS patients' MDS-UPDRS-III score improved 11.3% and 37% after levodopa, respectively. Rest tremor showed the largest improvement, while axial signs did not improve in LSPD. However, the magnitude of levodopa response significantly correlated with dyskinesias severity in LSPD patients. One third of LSPD and 9% of DBS patients reported moderate drowsiness. Conclusions: LSPD patients show a slight response to a supra-maximal levodopa dose, which is greater if dyskinesia are present, but it is frequently associated with adverse effects. A decrease in levodopa response is a potential marker of disease progression in LSPD.

Original languageEnglish
JournalParkinsonism and Related Disorders
DOIs
Publication statusAccepted/In press - Jan 7 2016

Fingerprint

Levodopa
Parkinson Disease
Deep Brain Stimulation
Dyskinesias
Social Adjustment
Sleep Stages
Tremor
Activities of Daily Living
England
Disease Progression

Keywords

  • Advanced stage
  • Late stage
  • Levodopa test
  • Parkinson's disease

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

Cite this

Fabbri, M., Coelho, M., Abreu, D., Guedes, L. C., Rosa, M. M., Costa, N., ... Ferreira, J. J. (Accepted/In press). Do patients with late-stage Parkinson's disease still respond to levodopa? Parkinsonism and Related Disorders. https://doi.org/10.1016/j.parkreldis.2016.02.021

Do patients with late-stage Parkinson's disease still respond to levodopa? / Fabbri, Margherita; Coelho, Miguel; Abreu, Daisy; Guedes, Leonor Correia; Rosa, Mario M.; Costa, Nilza; Antonini, Angelo; Ferreira, Joaquim J.

In: Parkinsonism and Related Disorders, 07.01.2016.

Research output: Contribution to journalArticle

Fabbri, Margherita ; Coelho, Miguel ; Abreu, Daisy ; Guedes, Leonor Correia ; Rosa, Mario M. ; Costa, Nilza ; Antonini, Angelo ; Ferreira, Joaquim J. / Do patients with late-stage Parkinson's disease still respond to levodopa?. In: Parkinsonism and Related Disorders. 2016.
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abstract = "Background: Late-stage Parkinson' disease (PD) is dominated by loss of autonomy due to motor and non-motor symptoms which can be marginally corrected by medications adjustments. However, controversy exists on the mechanisms underlying the apparent decrease of benefit from levodopa. Objective: To study the response to levodopa in late-stage PD (LSPD). Methods: 20 LSPD patients (Schwab and England ADL Scale 3 in MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (DBS) underwent an acute levodopa challenge test. MDS-UPDRS-III and the modified Abnormal Involuntary Movement Scale were evaluated in off and after administration of a supra-maximal levodopa dose. Results: LSPD patients had a median age of 78.8 (IQR: 73.5-82) and median disease duration of 14 years (IQR: 10-19.75). DBS patients had a median age of 66 (IQR: 61-72) and median disease duration of 18 years (IQR: 15-22). LSPD and DBS patients' MDS-UPDRS-III score improved 11.3{\%} and 37{\%} after levodopa, respectively. Rest tremor showed the largest improvement, while axial signs did not improve in LSPD. However, the magnitude of levodopa response significantly correlated with dyskinesias severity in LSPD patients. One third of LSPD and 9{\%} of DBS patients reported moderate drowsiness. Conclusions: LSPD patients show a slight response to a supra-maximal levodopa dose, which is greater if dyskinesia are present, but it is frequently associated with adverse effects. A decrease in levodopa response is a potential marker of disease progression in LSPD.",
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AU - Coelho, Miguel

AU - Abreu, Daisy

AU - Guedes, Leonor Correia

AU - Rosa, Mario M.

AU - Costa, Nilza

AU - Antonini, Angelo

AU - Ferreira, Joaquim J.

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N2 - Background: Late-stage Parkinson' disease (PD) is dominated by loss of autonomy due to motor and non-motor symptoms which can be marginally corrected by medications adjustments. However, controversy exists on the mechanisms underlying the apparent decrease of benefit from levodopa. Objective: To study the response to levodopa in late-stage PD (LSPD). Methods: 20 LSPD patients (Schwab and England ADL Scale 3 in MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (DBS) underwent an acute levodopa challenge test. MDS-UPDRS-III and the modified Abnormal Involuntary Movement Scale were evaluated in off and after administration of a supra-maximal levodopa dose. Results: LSPD patients had a median age of 78.8 (IQR: 73.5-82) and median disease duration of 14 years (IQR: 10-19.75). DBS patients had a median age of 66 (IQR: 61-72) and median disease duration of 18 years (IQR: 15-22). LSPD and DBS patients' MDS-UPDRS-III score improved 11.3% and 37% after levodopa, respectively. Rest tremor showed the largest improvement, while axial signs did not improve in LSPD. However, the magnitude of levodopa response significantly correlated with dyskinesias severity in LSPD patients. One third of LSPD and 9% of DBS patients reported moderate drowsiness. Conclusions: LSPD patients show a slight response to a supra-maximal levodopa dose, which is greater if dyskinesia are present, but it is frequently associated with adverse effects. A decrease in levodopa response is a potential marker of disease progression in LSPD.

AB - Background: Late-stage Parkinson' disease (PD) is dominated by loss of autonomy due to motor and non-motor symptoms which can be marginally corrected by medications adjustments. However, controversy exists on the mechanisms underlying the apparent decrease of benefit from levodopa. Objective: To study the response to levodopa in late-stage PD (LSPD). Methods: 20 LSPD patients (Schwab and England ADL Scale 3 in MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (DBS) underwent an acute levodopa challenge test. MDS-UPDRS-III and the modified Abnormal Involuntary Movement Scale were evaluated in off and after administration of a supra-maximal levodopa dose. Results: LSPD patients had a median age of 78.8 (IQR: 73.5-82) and median disease duration of 14 years (IQR: 10-19.75). DBS patients had a median age of 66 (IQR: 61-72) and median disease duration of 18 years (IQR: 15-22). LSPD and DBS patients' MDS-UPDRS-III score improved 11.3% and 37% after levodopa, respectively. Rest tremor showed the largest improvement, while axial signs did not improve in LSPD. However, the magnitude of levodopa response significantly correlated with dyskinesias severity in LSPD patients. One third of LSPD and 9% of DBS patients reported moderate drowsiness. Conclusions: LSPD patients show a slight response to a supra-maximal levodopa dose, which is greater if dyskinesia are present, but it is frequently associated with adverse effects. A decrease in levodopa response is a potential marker of disease progression in LSPD.

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