Choudhury Supriyo, Pradhan Richeek, Paul Pritikanta, Das Manisha, Gupta Anupam, Ghosh Pahari, Chatterjee Suparna
Neurol Res. 2014 Sep;36(9):841-6. doi: 10.1179/1743132814Y.0000000339. Epub 2014 Mar 7.
Levodopa-induced dyskinesia (LID) is one of the most disabling complications of long-term pharmacotherapy of Parkinson's disease (PD). The objective of our study was to examine the clinical profile and determinants of severity of LID in Indian PD patients on levodopa therapy.
Retrospective analysis of records of PD patients with LID was performed. All patients were on levodopa and carbidopa combination. Records of subjects with complete information about disease profile, drug intake, and dyskinesia were analyzed. Characterization of LID was based on responses to part IV of unified Parkinson's disease rating scale (UPDRS).
Records of 42 patients (M∶F = 4·6∶1) were analyzed. The median Hoehn and Yahr (H&Y) stage was 2·5 while median duration of levodopa therapy was 6·16 years (range: 1·91-14·58). Early morning dystonia was reported by 97·6% of the patients. Patients treated with ≧2 concomitant PD medication reported a significantly lower median UPDRS IV A score compared to patients treated with <2 number of concomitant drugs. A trend toward a lower UPDRS IV A score was associated with use of dopamine agonists (DA). Patients with H&Y score ≧3 had a significantly higher median total UPDRS IV A score than patients with H&Y score <3.
Early morning dystonia might be more common among Indian patients of LID. Use of a higher number of concomitant PD medications alongside levodopa is associated with a reduced severity of dyskinesia, even on prolonged use. Levodopa-induced dyskinesia is not only a drug-related phenomenon but the stage of PD itself also affects the dyskinesia severity.
左旋多巴诱发的异动症（LID）是帕金森病（PD）长期药物治疗最致残的并发症之一。我们研究的目的是调查接受左旋多巴治疗的印度PD患者LID的临床特征及严重程度的决定因素。
对患有LID的PD患者的记录进行回顾性分析。所有患者均接受左旋多巴和卡比多巴联合治疗。分析具有疾病概况、药物摄入和异动症完整信息的受试者记录。LID的特征基于对统一帕金森病评定量表（UPDRS）第四部分的反应。
分析了42例患者的记录（男∶女 = 4.6∶1）。Hoehn和Yahr（H&Y）分期的中位数为2.5，而左旋多巴治疗的中位数持续时间为6.16年（范围：1.91 - 14.58年）。97.6%的患者报告有清晨肌张力障碍。与接受<2种伴随PD药物治疗的患者相比，接受≧2种伴随PD药物治疗的患者报告的UPDRS IV A评分中位数显著更低。使用多巴胺激动剂（DA）与UPDRS IV A评分降低的趋势相关。H&Y评分≧3的患者的UPDRS IV A总评分中位数显著高于H&Y评分<3的患者。
清晨肌张力障碍在印度LID患者中可能更常见。左旋多巴联合使用更多种类的伴随PD药物与异动症严重程度降低相关，即使长期使用也是如此。左旋多巴诱发的异动症不仅是一种与药物相关的现象，PD本身的分期也会影响异动症的严重程度。
