Athulya R T, Jayakrishnan S, Iype Thomas, Rajan Reeja, Alapatt Paul J
Department of Hospital and Clinical Pharmacy, College of Pharmaceutical Sciences, Thiruvananthapuram, Kerala, India.
Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India.
Ann Indian Acad Neurol. 2020 Jan-Feb;23(1):44-47. doi: 10.4103/aian.AIAN_460_18.
Levodopa has a superior antiparkinsonian effect than dopamine agonists making it the standard of care for patients with Parkinson's disease (PD). During the initial stages, PD patients show a steady response to levodopa. Response fluctuations and levodopa-induced dyskinesias (LID) develop subsequently. The timing and onset of dyskinesias vary among individuals, and there are very few studies identifying the predictors of dyskinesia in India.
We aimed to study the clinical profile, disability, and predictors of LID in a patient with PD.
This was a cross-sectional observational study of consecutive patients with PD attending our movement disorder clinic. Patients on levodopa treatment with a minimum follow-up of 6 months were included in the study. All patients were observed before and after administration of levodopa to assess onset, duration of action, and timing of dyskinesias. Dyskinesias were video recorded and classified. Bivariate analysis was performed using Chi-square test or Fisher's exact test and multivariate analysis using binary logistic regression.
This study recruited 110 patients with PD on levodopa therapy. Thirty-one (28.1%) out of 110 had LID. Of these, 25 patients (80.6%) had on-time dyskinesia, 19 patients (61.3%) had off-time dystonia, and 13 patients (41.9%) had diphasic dyskinesia. Majority had only mild-to-moderate dyskinesia. Incapacitating dyskinesias were during off time, primarily affecting the foot. Age, disease duration, disease severity, duration of treatment, and total dose of levodopa were found to be predictors of LID. Multivariate regression analysis showed younger age and longer duration of levodopa treatment to be independent predictors for LID.
LID is fairly common in PD though not severely disabling. Patients with younger age of onset, longer disease duration, and severe disease were more likely to get early LID. We observed the lower prevalence of LID when initiating at lower doses and slow titration of levodopa.
左旋多巴比多巴胺激动剂具有更优的抗帕金森病作用，使其成为帕金森病（PD）患者的标准治疗药物。在疾病初期，PD患者对左旋多巴表现出稳定的反应。随后会出现反应波动和左旋多巴诱发的异动症（LID）。异动症的发生时间和起始情况因人而异，而在印度，很少有研究确定异动症的预测因素。
我们旨在研究PD患者的临床特征、残疾情况以及LID的预测因素。
这是一项对在我们运动障碍门诊就诊的连续PD患者进行的横断面观察性研究。研究纳入了接受左旋多巴治疗且随访至少6个月的患者。在给予左旋多巴前后观察所有患者，以评估异动症的起始、作用持续时间和发生时间。对异动症进行录像并分类。采用卡方检验或Fisher精确检验进行双变量分析，采用二元逻辑回归进行多变量分析。
本研究招募了110例接受左旋多巴治疗的PD患者。110例中有31例（28.1%）出现LID。其中，25例患者（80.6%）出现按时异动症，19例患者（61.3%）出现关期肌张力障碍，13例患者（41.9%）出现双相异动症。大多数患者仅有轻度至中度异动症。致残性异动症发生在关期，主要影响足部。年龄、病程、疾病严重程度、治疗持续时间和左旋多巴总剂量被发现是LID的预测因素。多变量回归分析显示，年龄较小和左旋多巴治疗持续时间较长是LID的独立预测因素。
LID在PD中相当常见，但致残性不强。发病年龄较小、病程较长和病情严重的患者更有可能早期出现LID。我们观察到，以较低剂量起始并缓慢滴定左旋多巴时，LID的患病率较低。
