Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
J Parkinsons Dis. 2023;13(1):3-23. doi: 10.3233/JPD-223536.
Balance impairment is a frequent cause of morbidity and mortality in people with Parkinson's disease (PD). As opposed to the effects of appendicular motor symptoms, the effects of Levodopa on balance impairment in idiopathic PD are less clear.
To review the literature on the effects of oral Levodopa on clinical balance test performance, posturography, step initiation, and responses to perturbation in people with idiopathic PD (PwPD).
A systematic search of three scientific databases (Pubmed, Embase, and Web of Science) was conducted in accordance with PRISMA guidelines. For the pilot meta-analysis, standardized mean differences with 95% confidence intervals were calculated using an inverse variance random effects model. Data not suitable for implementation in the meta-analysis (missing means or standard deviations, and non-independent outcomes) were analyzed narratively.
A total of 2772 unique studies were retrieved, of which 18 met the eligibility criteria and were analyzed, including data of 710 idiopathic PwPD. Levodopa had a significant positive effect on the Berg Balance Scale, the Push and Release test, and jerk and frequency parameters during posturography. In contrast, some significant negative effects on velocity-based sway parameters were found during posturography and step initiation. However, Levodopa had no significant effect on most step initiation- and all perturbation parameters.
The effects of Levodopa on balance in PwPD vary depending on the outcome parameters and patient inclusion criteria. A systematic approach with well-defined outcome parameters, and prespecified, sensitive and reliable tests is needed in future studies to unravel the effects of oral Levodopa on balance.
平衡障碍是帕金森病（PD）患者发病率和死亡率的一个常见原因。与四肢运动症状的影响相反，左旋多巴对特发性 PD 患者平衡障碍的影响尚不明确。
综述左旋多巴对特发性帕金森病患者临床平衡测试表现、姿势描记术、起始步和对扰动反应的影响的文献。
根据 PRISMA 指南，对三个科学数据库（Pubmed、Embase 和 Web of Science）进行了系统搜索。对于初步荟萃分析，使用逆方差随机效应模型计算标准化均数差值及其 95%置信区间。不适合进行荟萃分析的数据（缺失均值或标准差和非独立结果）进行了叙述性分析。
共检索到 2772 篇独特的研究，其中 18 项符合入选标准并进行了分析，包括 710 例特发性 PD 患者的数据。左旋多巴对 Berg 平衡量表、推和释放测试以及姿势描记术的 jerk 和频率参数有显著的积极影响。相比之下，在姿势描记术和起始步中，发现了一些与速度相关的摆动参数的显著负面影响。然而，左旋多巴对大多数起始步和所有扰动参数均无显著影响。
左旋多巴对 PD 患者平衡的影响取决于结果参数和患者纳入标准。未来的研究需要采用系统的方法，明确界定结果参数，并采用预设的、敏感和可靠的测试，以揭示口服左旋多巴对平衡的影响。
