Dyskinesias and motor fluctuations in Parkinson's disease

Abstract

We investigated the prevalence of dyskinesias and motor fluctuations, and the factors determining their occurrence, in a community-based population of patients with Parkinson's disease. Among 124 patients with Parkinson's disease, 87 (70%) had received a levodopa preparation. Among these 87 patients, 28% were experiencing treatment-induced dyskinesias and 40% response fluctuations. The prevalence of motor fluctuations was best predicted by disease duration and dose of levodopa, whereas dyskinesias could be best predicted by duration of treatment. Patients with a shorter time from symptom onset to initiation of levodopa and younger patients had developed motor complications earlier, and patients who had started treatment with a dopamine agonist had developed these treatment complications later. Although a satisfactory response to medication was associated with higher rates of motor complications, poor or moderate response was associated with lower quality of life in patients with a disease duration of </=5 years or >/=10 years. We conclude that motor fluctuations are most strongly related to disease duration and dose of levodopa, and dyskinesias to duration of levodopa treatment. However, poorer quality of life associated with inadequate dosage of levodopa may be the price for a low rate of motor complications in patients with Parkinson's disease.

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.…”

“…With respect to the second research question, our findings confirm the results by others showing that motor complications are perhaps the greatest concern for PD patients who receive high cumulative dopaminergic doses (Nicoletti et al., 2016; Yoritaka et al., 2013; Larsen et al., 2000; Schrag & Quinn, 2000; Scott et al., 2016; Warren Olanow et al., 2013). Instead of levodopa daily dose, we chose LEDD as a total daily dose of medication expressing dose intensity of different antiparkinsonian drug regimens.…”

“…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.…”