Department of Neurology and Movement Disorder Center, College of Medicine, Seoul National University, Seoul, Korea.
John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Mov Disord. 2020 Jan;35(1):185-190. doi: 10.1002/mds.27882. Epub 2019 Nov 11.
Long-term population-representative data on motor fluctuations and levodopa-induced dyskinesias in Parkinson's disease is lacking.
The Cambridgeshire Parkinson's Incidence from GP to Neurologist (CamPaIGN) cohort comprises incident PD cases followed for up to 13 years (n = 141). Cumulative incidence of motor fluctuations and levodopa-induced dyskinesias and risk factors were assessed using Kaplan-Meyer and Cox regression analyses.
Cumulative incidence of motor fluctuations and levodopa-induced dyskinesias was 54.3% and 14.5%, respectively, at 5 years and 100% and 55.7%, respectively, at 10 years. Higher baseline UPDRS-total and SNCA rs356219(A) predicted motor fluctuations, whereas higher baseline Mini-mental State Examination and GBA mutations predicted levodopa-induced dyskinesias. Early levodopa use did not predict motor complications. Both early motor fluctuations and levodopa-induced dyskinesias predicted reduced mortality in older patients (age at diagnosis >70 years).
Our data support the hypothesis that motor complications are related to the severity of nigrostriatal pathology rather than early levodopa use and indicate that early motor complications do not necessarily confer a negative prognosis. © 2019 International Parkinson and Movement Disorder Society.
帕金森病中运动波动和左旋多巴诱导性运动障碍的长期人群代表性数据缺乏。
从全科医生到神经科医生的剑桥帕金森病发病研究（CamPaIGN）队列包括 141 名接受长达 13 年随访的新发帕金森病病例。使用 Kaplan-Meier 和 Cox 回归分析评估运动波动和左旋多巴诱导性运动障碍的累积发病率和危险因素。
运动波动和左旋多巴诱导性运动障碍的累积发病率分别为 5 年时的 54.3%和 14.5%，10 年时的 100%和 55.7%。较高的基线 UPDRS 总分和 SNCA rs356219(A) 预测运动波动，而较高的基线简易精神状态检查和 GBA 突变预测左旋多巴诱导性运动障碍。早期使用左旋多巴并不能预测运动并发症。早期运动波动和左旋多巴诱导性运动障碍都预示着较年长患者（诊断时年龄>70 岁）死亡率降低。
我们的数据支持运动并发症与黑质纹状体病理严重程度相关而与早期左旋多巴使用无关的假设，并表明早期运动并发症不一定带来负面预后。© 2019 国际帕金森病和运动障碍学会。
