Department of Neurology, University of Cincinnati College of Medicine , Cincinnati, OH , USA ; Gardner Center for Parkinson's and Movement Disorders, University of Cincinnati Neuroscience Institute , Cincinnati, OH , USA ; Veterans Affairs Medical Center , Cincinnati, OH , USA.
Department of Neurology, University of Cincinnati College of Medicine , Cincinnati, OH , USA.
Front Neurol. 2013 Dec 13;4:202. doi: 10.3389/fneur.2013.00202. eCollection 2013.
The effect of dopaminergic therapy on balance in Parkinson's disease (PD) remains unclear, including previous studies that excluded the effect of dyskinesias or other involuntary movements on postural sway. Additionally, medication's effects may differ between fallers and non-fallers. In this study, the authors quantify the effect of dopaminergic medication on postural balance (sway) in advanced PD, with and without dyskinesias, and consider the patient's history of falls.
In 24 patients with advanced idiopathic PD, postural balance was measured using a strain-gage force platform. Before and after taking dopaminergic medication, the patient's postural sway was measured at 30-s intervals to determine sway length (SL) and sway area (SA). Data analysis included the presence of dyskinesias during "ON" medication condition and history of previous falls.
No significant changes occurred in SL or SA with dopaminergic treatment for fallers without dyskinesias or non-fallers with dyskinesias. However, after dopaminergic treatment, SL and SA were 37.8 and 45% lower, respectively, in non-fallers without dyskinesias (indicating better balance) and were 87.4 and 162.8% higher, respectively, in fallers with dyskinesias (indicating poorer balance). In the ON-medication condition, SL and SA were larger in patients with dyskinesias when compared with patients without dyskinesias; SL was larger in fallers than non-fallers in both groups with or without dyskinesias.
Dopaminergic medication effects on postural sway could be a predictive factor for fall risk in PD patients with and without dyskinesias: specifically, decreased sway could indicate minimal fall risk whereas no change or increased postural sway could indicate a high risk.
多巴胺能治疗对帕金森病（PD）平衡的影响仍不清楚，包括以前的研究排除了不自主运动或其他运动对姿势摆动的影响。此外，药物的作用可能在跌倒者和非跌倒者之间有所不同。在这项研究中，作者量化了多巴胺能药物对伴有和不伴有不自主运动的晚期 PD 患者姿势平衡（摆动）的影响，并考虑了患者的跌倒史。
在 24 例晚期特发性 PD 患者中，使用应变计力平台测量姿势平衡。在服用多巴胺能药物前后，患者的姿势摆动以 30 秒的间隔进行测量，以确定摆动长度（SL）和摆动面积（SA）。数据分析包括“ON”药物状态下是否存在不自主运动以及是否有既往跌倒史。
对于无不自主运动的跌倒者和有不自主运动的非跌倒者，多巴胺能治疗后 SL 或 SA 无显著变化。然而，在接受多巴胺能治疗后，无不自主运动的非跌倒者的 SL 和 SA 分别降低了 37.8%和 45%（表明平衡更好），而有不自主运动的跌倒者的 SL 和 SA 分别升高了 87.4%和 162.8%（表明平衡更差）。在 ON 药物状态下，有不自主运动的患者的 SL 和 SA 大于无不自主运动的患者；在有或没有不自主运动的两组患者中，SL 在跌倒者中大于非跌倒者。
多巴胺能药物对姿势摆动的影响可能是 PD 患者伴或不伴不自主运动跌倒风险的预测因素：具体来说，摆动减小可能表明跌倒风险最小，而无变化或姿势摆动增加可能表明风险较高。
