Abstract
Background and purpose
Levodopa treatment in Parkinson's disease (PD) causes motor fluctuations and dyskinesias, but few data describe their development or severity in unselected incident cohorts.
Methods
Demographic, clinical, treatment, smoking, caffeine and alcohol data from 183 people with PD were gathered from the Parkinsonism Incidence in Northeast Scotland (PINE) study, a community-based, incident cohort. With Kaplan–Meier survival analysis and Cox regression modelling the development, and severity, of dyskinesias and motor fluctuations and which factors independently influenced their onset were assessed.
Results
After a mean follow-up of 59 months, 39 patients (21.3%) developed motor fluctuations and 52 (28.4%) developed dyskinesias. Kaplan–Meier estimates of the probability of motor fluctuations and dyskinesias after 5 years of dopaminergic treatment were 29.2% [95% confidence interval (CI) 21.5%–38.8%] and 37.0% (95% CI 28.5%–47.1%) respectively. 19.8% developed motor fluctuations requiring treatment changes but only 4.0% (95% CI 1.5%–10.4%) developed dyskinesias requiring treatment changes by 5 years. Cumulative levodopa dose [hazard ratio (HR) 1.38 (95% CI 1.19–1.60)], female sex [HR 2.41 (1.19–4.89)] and younger age at diagnosis [HR 1.08 (1.04–1.11)] were independently associated with development of motor fluctuations. Cumulative levodopa dose [HR 1.23 (1.08–1.40)] and female sex [HR 2.51 (1.40–4.51)] were independently associated with dyskinesias. In exploratory analyses, moderate caffeine exposure was associated with fewer motor fluctuations, longer symptom duration with more dyskinesias, and tremor at diagnosis with higher rates of both complications.
Conclusions
In this community-based incident PD cohort, severe dyskinesias were rare. Cumulative levodopa dose was the strongest predictor of both dyskinesias and motor fluctuations.
Levodopa treatment in Parkinson's disease (PD) causes motor fluctuations and dyskinesias, but few data describe their development or severity in unselected incident cohorts.
Methods
Demographic, clinical, treatment, smoking, caffeine and alcohol data from 183 people with PD were gathered from the Parkinsonism Incidence in Northeast Scotland (PINE) study, a community-based, incident cohort. With Kaplan–Meier survival analysis and Cox regression modelling the development, and severity, of dyskinesias and motor fluctuations and which factors independently influenced their onset were assessed.
Results
After a mean follow-up of 59 months, 39 patients (21.3%) developed motor fluctuations and 52 (28.4%) developed dyskinesias. Kaplan–Meier estimates of the probability of motor fluctuations and dyskinesias after 5 years of dopaminergic treatment were 29.2% [95% confidence interval (CI) 21.5%–38.8%] and 37.0% (95% CI 28.5%–47.1%) respectively. 19.8% developed motor fluctuations requiring treatment changes but only 4.0% (95% CI 1.5%–10.4%) developed dyskinesias requiring treatment changes by 5 years. Cumulative levodopa dose [hazard ratio (HR) 1.38 (95% CI 1.19–1.60)], female sex [HR 2.41 (1.19–4.89)] and younger age at diagnosis [HR 1.08 (1.04–1.11)] were independently associated with development of motor fluctuations. Cumulative levodopa dose [HR 1.23 (1.08–1.40)] and female sex [HR 2.51 (1.40–4.51)] were independently associated with dyskinesias. In exploratory analyses, moderate caffeine exposure was associated with fewer motor fluctuations, longer symptom duration with more dyskinesias, and tremor at diagnosis with higher rates of both complications.
Conclusions
In this community-based incident PD cohort, severe dyskinesias were rare. Cumulative levodopa dose was the strongest predictor of both dyskinesias and motor fluctuations.
| Original language | English |
|---|---|
| Pages (from-to) | 304-312 |
| Number of pages | 9 |
| Journal | European Journal of Neurology |
| Volume | 23 |
| Issue number | 2 |
| Early online date | 13 Jun 2015 |
| DOIs | |
| Publication status | Published - Feb 2016 |
Bibliographical note
AcknowledgementsWe acknowledge funding for the PINE study from Parkinson's UK, the Scottish Chief Scientist Office, the BMA Doris Hillier Award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian Endowments and SPRING. We thank the patients for their participation and the research staff who collected data and supported the study database.
Nicholas W Scott: no financial disclosures. Angus D Macleod: funded by a Clinical Academic Fellowship from the Scottish Chief Scientist Office; also received research funding from Parkinson's UK. Carl E Counsell: research funding from Parkinson's UK, Scottish Chief Scientist Office, National Institute of Health Research, and Engineering and Physical Sciences Research Council.
Keywords
- Parkinson's disease
- motor fluctuations
- dyskinesias
- motor complications
- levodopa
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Parkinsonism Incidence in North East Scotland (PINE) study database
Counsell, C. (Owner), Wilde, K. (Creator) & Ritchie, D. M. (Data Manager), University of Aberdeen, 1 Apr 2009
Dataset