Fiores Roberta De, Martino Iolanda, Quattrone Andrea, Vescio Basilio, Arabia Gennarina, Gambardella Antonio, Morelli Maurizio
Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy.
Neuroscience Research Center, Magna Graecia University, 88100 Catanzaro, Italy.
Clin Park Relat Disord. 2025 May 7;12:100343. doi: 10.1016/j.prdoa.2025.100343. eCollection 2025.
Non-motor fluctuations (NMF) represent one of the main complications that patients with Parkinson's disease (PD) may experience during long-term levodopa treatment. Opicapone (OPC), a COMT-inhibitor indicated for end-of-dose motor fluctuations (MF), has not been extensively investigated for the management of NMF. We evaluate the efficacy of OPC on end-of-dose neuropsychiatric fluctuations, the most frequent and severe NMF.
We assessed 15 PD patients who underwent treatment with OPC (PD-OPC) compared to a control group of 15 PD patients (PD-CTRL). All patients had end-of-dose MF and NMF, confirmed by 19-item Wearing-Off Questionnaire (WOQ-19). For each, we identified the first end-of-dose deterioration period through MDS-UPDRS-III administered every 30 min over two consecutive days. On the third day, a comprehensive clinical and neuropsychological battery was administered during this designated period. Subsequently, OPC was prescribed to PD-OPC. After 6 months, patients were re-evaluated using the same baseline assessments during the same end-of-dose period.
At 6-month follow-up, PD-OPC showed significant improvement in the following tests: WOQ-19 ( < 0.001), total MDS-UPDRS and each of its four parts ( < 0.001), NMSS ( < 0.001), executive functions/attention (Weigl's, < 0.001; FAS, < 0.001; FAB, < 0.001; STROOP, = 0.001) and mood related-symptoms (BDI-II, HAM-A; both = 0.001). There was a slightly significant difference in Visual Search ( = 0.018), and no differences in RAVLT-I = 0.323), and RAVLT-D ( = 0.155) scores. At follow-up, PD-CTRL showed no significant differences in WOQ-19, motor scales, and neuropsychological tests compared to baseline.
OPC improved end-of-dose fluctuations in anxiety/depression, and executive functions/attention, while memory and visuospatial abilities showed little or no significant changes.
非运动波动（NMF）是帕金森病（PD）患者在长期左旋多巴治疗过程中可能出现的主要并发症之一。奥匹卡朋（OPC）是一种用于治疗剂末运动波动（MF）的儿茶酚-O-甲基转移酶（COMT）抑制剂，尚未对其治疗NMF进行广泛研究。我们评估了OPC对最常见且严重的剂末神经精神波动的疗效。
我们评估了15例接受OPC治疗的PD患者（PD-OPC组），并与15例PD患者的对照组（PD-CTRL组）进行比较。所有患者均有剂末MF和NMF，通过19项脱逸问卷（WOQ-19）确认。对于每组患者，我们通过连续两天每30分钟进行一次的MDS-UPDRS-III量表确定首个剂末病情恶化期。在第三天，在这个指定时间段内进行全面的临床和神经心理测试。随后，为PD-OPC组患者开具OPC处方。6个月后，在相同的剂末时间段使用相同的基线评估方法对患者进行重新评估。
在6个月的随访中，PD-OPC组在以下测试中显示出显著改善：WOQ-19（<0.001）、MDS-UPDRS总分及其四个部分中的每一部分（<0.001）、NMSS（<0.001）、执行功能/注意力（韦格氏测试，<0.001；FAS测试，<0.001；FAB测试，<0.00I；斯特鲁普测试，=0.001）以及情绪相关症状（BDI-II量表、HAM-A量表；两者均=0.001）。视觉搜索测试存在轻微显著差异（=0.018），而雷伊听觉词语学习测验-即时回忆（RAVLT-I，=0.323）和雷伊听觉词语学习测验-延迟回忆（RAVLT-D，=0.155）得分无差异。在随访时相比基线，PD-CTRL组在WOQ-19、运动量表和神经心理测试方面无显著差异。
OPC改善了焦虑/抑郁以及执行功能/注意力方面的剂末波动，而记忆和视觉空间能力几乎没有显著变化或无显著变化。
