Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA.
Mov Disord. 2013 Mar;28(3):341-6. doi: 10.1002/mds.25321. Epub 2013 Feb 6.
Numerous scales assess dyskinesia in Parkinson's disease (PD), variably focusing on anatomical distribution, phenomenology, time, severity, and disability. No study has compared these scales and their relative ability to detect change related to an established treatment. We conducted a randomized placebo-controlled trial of amantadine, assessing dyskinesia at baseline and at 4 and 8 weeks using the following scales: Unified Dyskinesia Rating Scale (UDysRS), Lang-Fahn Activities of Daily Living Dyskinesia Rating Scale (LF), 26-Item Parkinson's Disease Dyskinesia scale (PDD-26), patient diaries, modified Abnormal Involuntary Movements Scale (AIMS), Rush Dyskinesia Rating Scale (RDRS), dyskinesia items from the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Clinical Global Impression (severity and change: CGI-S, CGI-C). Scale order was randomized at each visit, but raters were aware of each scale as it was administered. Sensitivity to treatment was assessed using effect size. Sixty-one randomized dyskinetic PD subjects (31 amantadine, 30 placebo) completed the study. Four of the 8 scales (CGI-C, LF, PDD-26, and UDysRS) detected a significant treatment. The UDysRS Total Score showed the highest effect size (η(2) = 0.138) for detecting treatment-related change, with all other scales having effect sizes < 0.1. No scale was resistant to placebo effects. This study resolves 2 major issues useful for future testing of new antidyskinesia treatments: among tested scales, the UDysRS, having both subjective and objective dyskinesia ratings, is superior for detecting treatment effects; and the magnitude of the UDysRS effect size from amantadine sets a clear standard for comparison for new agents.
许多量表评估帕金森病（PD）的运动障碍，不同程度地侧重于解剖分布、现象学、时间、严重程度和残疾。没有研究比较过这些量表及其相对能力，以检测与既定治疗相关的变化。我们进行了金刚烷胺的随机安慰剂对照试验，使用以下量表在基线和 4 周和 8 周评估运动障碍：统一运动障碍评分量表（UDysRS）、Lang-Fahn 日常生活活动障碍评分量表（LF）、26 项帕金森病运动障碍量表（PDD-26）、患者日记、改良不自主运动量表（AIMS）、Rush 运动障碍评分量表（RDRS）、运动障碍协会赞助的统一帕金森病评定量表（MDS-UPDRS）修订版的运动障碍项目，以及临床总体印象（严重程度和变化：CGI-S、CGI-C）。每次就诊时量表的顺序都是随机的，但评分者在进行评估时都知道每个量表。使用效应大小评估对治疗的敏感性。61 名随机运动障碍 PD 受试者（31 名金刚烷胺，30 名安慰剂）完成了研究。8 个量表中的 4 个（CGI-C、LF、PDD-26 和 UDysRS）检测到了治疗的显著效果。UDysRS 总评分显示出检测与治疗相关的变化的最高效应量（η²=0.138），所有其他量表的效应量均<0.1。没有一个量表不受安慰剂效应的影响。这项研究解决了未来测试新抗运动障碍治疗方法的两个主要问题：在所测试的量表中，UDysRS 具有主观和客观的运动障碍评分，更适合检测治疗效果；并且金刚烷胺的 UDysRS 效应量大小为新药物的比较设定了明确的标准。
