Clinical spectrum of levodopa‐induced complications

Aquino, Camila C.; Fox, Susan H.

doi:10.1002/mds.26125

Cited by 215 publications

(163 citation statements)

References 125 publications

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…As the disease progresses, however, levodopa becomes less effective, and larger doses are needed to achieve the same effect, increasing the risk of unwanted side effects and motor complications (Aquino & Fox, 2015; Vijayakumar & Jankovic, 2016). Dyskinesias are involuntary movements, usually affecting face and limbs, most typically presenting as peak dose or biphasic.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with motor complications in Parkinson's disease

et al. 2017

View full text Add to dashboard Cite

ObjectivesLevodopa is the most effective therapy for treating Parkinson's disease (PD); however, side effects such as dyskinesias and motor fluctuations may occur after some years of its usage. The aims of this study were to assess the frequency of and factors associated with motor complications among PD patients on levodopa treatment.MethodsIn a cross‐sectional study carried out in 2010–2013, clinical data and treatment details were collected. Logistic regression expressed by odd ratios (OR) and 95% confidence intervals (CI) was conducted to examine the effects of several independent variables on the occurrence of motor complications.ResultsA total of 455 patients were enrolled, among whom 374 were on levodopa. Analysis was performed in 328 patients whose exact duration of levodopa treatment was known. Among patients included in the analysis, 25.9% experienced motor complications; of these, 21% had dyskinesias and 20.1% had motor fluctuations. Based on logistic regression, statistically significant factors associated with the occurrence of motor complications were younger age at onset of the disease, higher levodopa equivalent daily dose (LEDD), shorter time to levodopa initiation, and akinetic‐rigid dominant phenotype of PD.ConclusionsThis study suggests that postponing the start of levodopa therapy and maintaining low daily doses of levodopa might reduce the risk of motor complications. Our results confirm that due to higher risk of motor complications, effectively treating patients with akinetic‐rigid dominant phenotype of PD might be more challenging than for patients whose dominant symptom is tremor.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Off‐period dystonia is another dyskinesia type that frequently involves the foot and leg; it is often painful and usually starts at night or early in the morning. Motor fluctuations are alterations of clinical state with “off”‐periods manifesting in worsening of motor symptoms (Aquino & Fox, 2015; Vijayakumar & Jankovic, 2016). …”

Section: Introductionmentioning

confidence: 99%

Factors associated with motor complications in Parkinson's disease

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The discovery of drugs replacing dopamine deficiency has a dramatic impact on quality of life and survival of PD patients [2]. After more than 40 years of use, levodopa (LD) remains the mainstream of pharmacological therapy for PD, particularly in the advanced disease stage [3]. Long-lasting treatment with LD, however, is associated with the occurrence of motor fluctuations and dyskinesia.…”

Section: Introductionmentioning

confidence: 99%

Levodopa/Carbidopa Intestinal Gel for Treatment of Advanced Parkinson’s Disease: An Update on the Effects of Cognitive Functions

Latino¹,

Tagliente²,

Pellicano³

et al. 2017

APD

View full text Add to dashboard Cite

Cognitive impairment is a frequent non-motorsymptom of Parkinson's disease (PD). In early disease stage, this takes the features of dysexecutive syndrome, and is mostly dependent on derangement of frontostriatal circuitries. In advanced stages, worsening of dysexecutive symptoms is accompanied by disorientation and memory deficit leading to dementia in 30% of cases, due to multiple neurotransmitter derangement. Dysexecutive symptoms in the early stages of PD may benefit from dopamine replacement therapy (DRT). Conversely, severe cognitive symptoms in more advanced stages are frequently aggravated by DRT. In particular, pulsatile stimulation of dopaminergic receptors by orally administered levodopa (LD) plays a significant negative role on cognitive and neuropsychiatric symptoms in advanced PD. The introduction of a gel of LD-carbidopa for continuous intestinal administration (LCIG) allows marked stabilization of plasma LD concentrations and provides benefit on motor fluctuations and dyskinesia of significantly greater magnitude than conventional oral administration in advanced PD patients. The results from several preliminary studies suggest that efficacy of LCGI on motor symptoms may be accompanied by good tolerability and potential benefit on several non-motor symptoms, including cognitive impairment. Future studies with longer observation period and larger cohorts are advised to confirm these preliminary observations.

show abstract

“…The magnitude of these side effects depends on the duration of treatment, duration of the disease, type of drug, and combination of drugs used [2]. While side effects of antiparkinsonian therapy are mostly related to the use of levodopa (L-dopa), dopamine agonists (DA), monoamine oxidase inhibitors (MAOBI), anticholinergics, amantadine, and catechol-O-methyl transferase inhibitors (COMTI) have also been implicated [3] [4] [5] [6] [7].…”

Section: Introductionmentioning

confidence: 99%

Medication Side Effect Profiles in PD Patients in a Safety-Net Hospital

Sisniega¹,

Madhusudhan²,

Rahmani³

et al. 2017

APD

View full text Add to dashboard Cite

Background: Compulsive behavior, dyskinesias, motor fluctuations, and hallucinations are common Parkinson's disease (PD) medication side effects.These are yet to be examined in relation to race and level of education. The goal of this analysis was to identify socioeconomic or clinical variables that are associated with compulsive behavior, dyskinesias, motor fluctuations, and hallucinations in patients in a safety-net hospital. Methods: A movement disorder patient database containing 452 patients with idiopathic PD was analyzed for differences in PD medication side effects using univariate and multivariate logistic regression analysis. Race, sex, and level of education were evaluated as possible confounders. Results: A greater proportion of the patients in this study were Caucasian males. The only variable associated with compulsive behavior was age, with higher age having a protective effect (p = 0.0336). Disease duration (defined as time since the onset of symptoms), diagnosis duration (time since formal diagnosis), and level of education were significantly associated with dyskinesia inunivariate analysis (p =< 0.0001, <0.0001, 0.1236 respectively). However, diagnosis duration was the only variable significantly associated with dyskinesia in multivariate analysis (p = 0.0038), in addition to a borderline significant association when comparing individuals with graduate degree to those who had completed high school education or less (p = 0.0599), with a protective effect of higher education. Disease duration, diagnosis duration, and use of monoamineoxidase inhibitors were also significantly associated with motor fluctuations in the univariate analysis, while only diagnosis duration was significantly associated with motor fluctuations in multivariate analysis (p = 0.0035) with longer diagnosis duration associated with higher risk of motor fluctuations. Age, disease duration, and diagnosis duration were associated with an increased risk of hallucinations

show abstract

Clinical spectrum of levodopa‐induced complications

Cited by 215 publications

References 125 publications

Factors associated with motor complications in Parkinson's disease

Factors associated with motor complications in Parkinson's disease

Levodopa/Carbidopa Intestinal Gel for Treatment of Advanced Parkinson’s Disease: An Update on the Effects of Cognitive Functions

Medication Side Effect Profiles in PD Patients in a Safety-Net Hospital

Contact Info

Product

Resources

About