Risk factors and predictors of levodopa-induced dyskinesia among multiethnic Malaysians with Parkinson's disease

Abstract

Chronic pulsatile levodopa therapy for Parkinson's disease (PD) leads to the development of motor fluctuations and dyskinesia. We studied the prevalence and predictors of levodopa-induced dyskinesia among multiethnic Malaysian patients with PD. Methods: This is a cross-sectional study involving 95 patients with PD on uninterrupted levodopa therapy for at least 6 months. The instrument used was the UPDRS questionnaires. The predictors of dyskinesia were determined using multivariate logistic regression analysis. Results: The mean age was 65.6 ± 8.5 years. The mean onset age was 58.5 ± 9.8 years. The median disease duration was 6 (7) years. Dyskinesia was present in 44% (n = 42) with median levodopa therapy of 3 years. There were 64.3% Chinese, 31% Malays, and 3.7% Indians and other ethnic groups. Eighty-one percent of patients with dyskinesia had clinical fluctuations. Patients with dyskinesia had lower onset age (p < 0.001), longer duration of levodopa therapy (p < 0.001), longer disease duration (p < 0.001), higher total daily levodopa dose (p < 0.001), and higher total UPDRS scores (p = 0.005) than patients without dyskinesia. The three significant predictors of dyskinesia were duration of levodopa therapy, onset age, and total daily levodopa dose.Conclusions: The prevalence of levodopa-induced dyskinesia in our patients was 44%. The most significant predictors were duration of levodopa therapy, total daily levodopa dose, and onset age.

Factors associated with motor complications in Parkinson's disease

“…With respect to the first research question, we found a slightly lower frequency of motor complications in our patients than several other studies (approximately 20% of our study participants with either of the motor complications vs. more than 22% of motor fluctuations and more than 26% of dyskinesias in other studies) (Nicoletti et al., 2016; Yoritaka et al., 2013; Martínez‐Martín et al., 2014; Hashim et al., 2014; Larsen et al., 2000; Schrag & Quinn, 2000). It is possible that the somewhat lower frequency of motor complications was partly due to the profile of the study participants.…”

“…and 548 mg in the study by Yoritaka et al.) (Yoritaka et al., 2013; Hashim et al., 2014). As this study was part of an epidemiologic survey of PD, all patients in the region were enrolled, included early cases.…”

“…Several studies have shown the prevalence of motor complications to increase with the duration of the disease (Nicoletti et al., 2016; Hashim et al., 2014; Schrag & Quinn, 2000; Scott, Macleod, & Counsell, 2016; García‐Ruiz, Del Val, Fernández, & Herranz, 2012; Stocchi et al., 2014). Motor complications may affect more than half of patients within 5 years of diagnosis (Bjornestad et al., 2016) and by the end of the first decade, up to 90% of patients may exhibit dyskinesia and 60% motor fluctuations (García‐Ruiz et al., 2012).…”

“…One of the longest follow‐up studies demonstrated that by the end of the second decade, motor complications were present in 100% of patients who were on at least 300 mg levodopa per day (Hely, Reid, Adena, Halliday, & Morris, 2008). Risk of development of motor complications may also rise in a dose‐dependent manner (Schrag & Quinn, 2000; Scott et al., 2016; Warren Olanow et al., 2013) but also in a levodopa duration‐dependent manner (Hashim et al., 2014; Schrag & Quinn, 2000). …”

“…Other variables that potentially increase the risk for motor complications have been reported: younger age at onset (Hashim et al., 2014; García‐Ruiz et al., 2012; Bjornestad et al., 2016; Warren Olanow et al., 2013), female gender (Yoritaka et al., 2013; Larsen et al., 2000; Schrag & Quinn, 2000; Scott et al., 2016; Bjornestad et al., 2016), initial treatment with levodopa (Schrag & Quinn, 2000; García‐Ruiz et al., 2012), and a higher score on the Unified Parkinson's Disease Rating Scale (UPDRS) Part II (Stocchi et al., 2014; Warren Olanow et al., 2013). Additionally, a low body weight (Warren Olanow et al., 2013) presence of tremor at diagnosis (Scott et al., 2016), higher levodopa equivalent dose, (Nicoletti et al., 2016) and higher MMSE score (Scott et al., 2016) have been shown to predict a higher rate of dyskinesias, while younger age (Stocchi et al., 2014; Bjornestad et al., 2016) and UPDRS Part III score (Bjornestad et al., 2016) predict a higher rate of motor fluctuations.…”