Movement Disorders Section, Raul Carrea Institute for Neurological Research, FLENI Buenos Aires, Argentina.
Int J Neurosci. 2010 Feb;120(2):137-43. doi: 10.3109/00207450903139663.
There is growing interest in developing inexpensive and objective motor fluctuation evaluation methods for Parkinson's disease (PD).
We aim to compare activity level in the off state, on state, and dyskinetic periods as evaluated either by a physician during a levodopa challenge or by a 72-hr on-off diary self-evaluation in the ambulatory setting. Finally, the effect of daily activities on motor activity in PD and healthy controls was further explored.
The study was conducted in three consecutive phases. For phase I, in which the on state, off state, and dyskinesia were evaluated using actigraphy, recordings were made during standard acute levodopa challenge in nine dyskinetic PD patients. For phase II, a different set of 16 dyskinetic PD patients was monitored in the ambulatory setting for 72 consecutive hours by actigraphy and a standardized on-off diary. For phase III, 62 PD patients and 14 age- and sex-matched healthy controls wore an actigraph and completed a daily activities diary for 7 days.
No differences in activity level between on state and off state during the acute levodopa challenge (phase I) or the 72-hr ambulatory period (phase II) were found. Activity during dyskinesia periods was significantly higher than during on state periods without dyskinesia (p < .01). During the third phase, dyskinetic PD patients and healthy controls showed higher actigraphy-measured activity as compared to de novo, stable, or fluctuating PD (p < .0001), which remained unaltered by daily activities performed during the study period. Tremor UPDRS scores did not correlate with activity level.
These results confirm the lack of specificity of simple wrist-worn actigraphy and further suggest it may be suitable for dyskinesia assessment but not for on state and off state evaluation.
人们对于开发廉价且客观的帕金森病（PD）运动波动评估方法的兴趣日益浓厚。
我们旨在比较在左旋多巴挑战期间由医生评估的静息期、活动期和不自主运动期，以及在活动状态下使用 72 小时开/关日记自我评估的活动水平。最后，进一步探讨了日常活动对 PD 患者和健康对照者运动活动的影响。
该研究分三个连续阶段进行。在第一阶段，使用活动记录仪评估运动障碍患者的活动期、静息期和不自主运动，在 9 名运动障碍 PD 患者的标准急性左旋多巴挑战期间进行记录。在第二阶段，使用活动记录仪和标准化的开/关日记对另一组 16 名运动障碍 PD 患者进行 72 小时连续监测。在第三阶段，62 名 PD 患者和 14 名年龄和性别匹配的健康对照者佩戴活动记录仪并填写 7 天日常活动日记。
在急性左旋多巴挑战期间（第一阶段）或 72 小时活动期间（第二阶段），活动水平在活动期和静息期之间没有差异。与无不自主运动的活动期相比，不自主运动期间的活动水平明显更高（p <.01）。在第三阶段，与新发、稳定或波动型 PD 相比，运动障碍 PD 患者和健康对照者的活动记录仪测量的活动水平更高（p <.0001），但在研究期间进行的日常活动并未改变这一结果。震颤 UPDRS 评分与活动水平无关。
这些结果证实了简单腕戴式活动记录仪缺乏特异性，进一步表明其可能适用于不自主运动评估，但不适用于活动期和静息期评估。
