Evolution of motor fluctuations in Parkinson's disease: A longitudinal study over 6 years

A prospective longitudinal 6‐year study of 34 patients with Parkinson's disease from the time of initiation of drug treatment explored changes in the motor response to L‐dopa over the early to mid disease course. Motor fluctuations developed in 41% after a mean L‐dopa treatment interval of 25 m...

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Bibliographic Details
Published in:Movement disorders 1999-07, Vol.14 (4), p.605-611
Main Authors: Reardon, Katrina A., Shiff, Mark, Kempster, Peter A.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Analysis of Variance
Antiparkinson Agents - therapeutic use
Biological and medical sciences
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Disease Progression
Dyskinesia
Female
Humans
L-Dopa
Levodopa - therapeutic use
Male
Medical sciences
Middle Aged
Motor fluctuation
Neurology
Parkinson Disease - drug therapy
Parkinson Disease - physiopathology
Parkinson's disease
Prospective Studies
Time Factors
Tropical medicine
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Summary:A prospective longitudinal 6‐year study of 34 patients with Parkinson's disease from the time of initiation of drug treatment explored changes in the motor response to L‐dopa over the early to mid disease course. Motor fluctuations developed in 41% after a mean L‐dopa treatment interval of 25 months and dyskinesia developed in 53% after a mean of 15 months' treatment. Patients who developed fluctuations had a significantly better response to L‐dopa than nonfluctuators. Nonfluctuators also had significantly greater “midline” motor disability affecting cranial and truncal muscles and gait. The development of motor fluctuations may simply reflect a retained capacity to respond to L‐dopa as endogenous dopaminergic neurotransmission declines with progressive nigral cell loss. Many patients who show no sign of motor fluctuation 5 or 6 years into the disease course have a relatively blunted response to L‐dopa. The proportion of such cases seems to correspond to the percentage that have coexisting striatal pathologic changes in postmortem studies.
ISSN:0885-3185
1531-8257
DOI:10.1002/1531-8257(199907)14:4<605::AID-MDS1009>3.0.CO;2-H