Schaeffer Eva, Maetzler Walter, Liepelt-Scarfone Inga, Sass Christian, Reilmann Ralf, Berg Daniela
Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3 , Tuebingen, 72076, Germany,
J Neural Transm (Vienna). 2015 Sep;122(9):1271-8. doi: 10.1007/s00702-015-1383-7. Epub 2015 Feb 25.
Although Levodopa-induced dyskinesias (LID) are one of the most compromising complications of dopaminergic treatment in Parkinson's disease (PD), there is no widely accepted assessment tool available that evaluates LID quantitatively. This is of relevance as objective assessment may help to facilitate proof-of-concept studies with novel treatments and thus eventually contribute to better patient care. PD patients were asked to perform a grip-lift task as well as tapping tasks assessed with the "Q-Motor" system. PD patients were separated into three groups according to their modified abnormal involuntary movement scale (M-AIMS)-score: PD patients without dyskinesias (PD(LID-) n = 17), with slight dyskinesias (PD(LID+) n = 15) and with severe dyskinesias (PD(LID++) n = 15). An explorative analysis to identify measures detecting LID was performed with 5 PD(LID-) and 5 PD(LID++) patients; these measures were then used in the remaining patients to assess the accuracy of the system to differentiate LID. The measures "Orientation-Index" and "Position-Index" of the grip-lift task differed significantly between the explorative cohorts. Using these two parameters for the differentiation of the remaining cohorts, the area under the ROC curve (AUC) yielded 0.809 for the differentiation of PD(LID-) vs. PD(LID++), 0.852 for the differentiation of PD(LID-) vs. PD(LID+) patients, and 0.830 for the differentiation of PD(LID+) and PD(LID++). The "Orientation-Index" and "Position-Index" of the Q-Motor assessment are sensitive, easy to apply and non-invasive measures for the objective assessment of manifestation and severity of LID.
尽管左旋多巴诱导的异动症（LID）是帕金森病（PD）多巴胺能治疗中最具损害性的并发症之一，但目前尚无广泛接受的可对LID进行定量评估的工具。这一点很重要，因为客观评估可能有助于推动新型治疗方法的概念验证研究，从而最终有助于改善患者护理。PD患者被要求执行抓握-提起任务以及使用“Q-Motor”系统评估的敲击任务。根据改良异常不自主运动量表（M-AIMS）评分，将PD患者分为三组：无异动症的PD患者（PD（LID-），n = 17）、有轻度异动症的患者（PD（LID+），n = 15）和有严重异动症的患者（PD（LID++），n = 15）。对5例PD（LID-）和5例PD（LID++）患者进行了探索性分析，以确定检测LID的指标；然后将这些指标用于其余患者，以评估该系统区分LID的准确性。抓握-提起任务的“方向指数”和“位置指数”在探索性队列之间存在显著差异。使用这两个参数对其余队列进行区分时，ROC曲线下面积（AUC）在区分PD（LID-）与PD（LID++）时为0.809，在区分PD（LID-）与PD（LID+）患者时为0.852，在区分PD（LID+）和PD（LID++）时为0.830。Q-Motor评估的“方向指数”和“位置指数”是用于客观评估LID表现和严重程度的敏感、易于应用且非侵入性的指标。
