Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test

Margherita Fabbri, Miguel Coelho, Leonor Correia Guedes, Ines Chendo, Catarina Sousa, Mario M Rosa, Daisy Abreu, Nilza Costa, Catarina Godinho, Angelo Antonini, Joaquim J Ferreira

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Abstract

BACKGROUND: Non-motor symptoms (NMS) are extremely common among late-stage Parkinson's disease (LSPD) patients. Levodopa (L-dopa) responsiveness seems to decrease with disease progression but its effect on NMS in LSPD still needs to be investigated.

OBJECTIVE: To assess the response of blood pressure (BP), pain, fatigue and anxiety to L-dopa in LSPD patients.

METHODS: 20 LSPD patients, defined as Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 (MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (advanced PD group) underwent an L-dopa challenge. BP and orthostatic hypotension (OH) assessment, a visual analogue scale (VAS) for pain and fatigue and the Strait Trait Anxiety (STAI) were evaluated before and after the L-dopa challenge.

RESULTS: Systolic BP dropped significantly after L-dopa intake (p < 0.05) in LSPD patients, while there was no change in pain, fatigue or anxiety. L-dopa significantly improved (p < 0.05) pain and anxiety in the advanced PD group, whereas it had no effect on BP or fatigue. L-dopa-related adverse effects (AEs), namely OH and sleepiness, were more common among LSPD patients. 40% and 65% of LSPD patients were not able to fill out the VAS and the STAI, respectively, while measurement of orthostatic BP was not possible in four LSPD patients.

CONCLUSIONS: This exploratory study concludes that some non-motor variables in LSPD do not benefit from the acute action of L-dopa while it can still induce disabling AEs. There is a need for assessment tools of NMS adapted to these disabled LSPD patients.

Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalParkinsonism and Related Disorders
Volume39
DOIs
Publication statusPublished - Jun 2017

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Fabbri, M., Coelho, M., Guedes, L. C., Chendo, I., Sousa, C., Rosa, M. M., Abreu, D., Costa, N., Godinho, C., Antonini, A., & Ferreira, J. J. (2017). Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test. Parkinsonism and Related Disorders, 39, 37-43. https://doi.org/10.1016/j.parkreldis.2017.02.007