Motor Complications In Patients With Parkinson’s Disease

Levodopa is still the most effective medication available in Parkinson’s disease (PD)treatment. However, once the "honeymoon" period has waned, usually after a few yearsof dopaminergic therapy, motor complications appear and have a significant impactupon quality of life. The aim of this study was to investigate the incidence and the riskfactors of motor complications in Parkinson’s disease. Demographic and medical datawere collected for each patient, including age, gender, educational background, smokinghistory, history of hypertension and diabetes, age at onset, disease duration, firstsymptom, initial treatment, duration of antiparkinsonian medications use,antiparkinsonian treatment(category, formulation, single dose and administration time ofdrugs). Patients receiving stable L-dopa therapy for≥30days completed the9-itemWearing-Off Questionnaire (WOQ-9). Patients who did not take L-dopa or the durationof L-dopa exposure less than30days were excluded. Physicians assessed each patientwith the WOQ-9regarding the presence of WO to clarify their actual WO condition.The modified abnormal involuntary movement scale (mAIMS) were used for thedetection of dyskinesia. The motor disability was evaluated with Unified Parkinson’sdisease rating scale (UPDRS) ē while disease severity was staging with Hoehn-Yahrscale. Statistical analysis was done using SPSS13.0.Result: Of the total116patients,62cases were males, and54were females. The mean age of the patients was (63.22±10.43)years (range35–86years). The mean daily dose of L-dopa use was (375.30±158.38)mg (range0.0–800.0mg), with the mean duration of L-dopa therapy was (43.67±39.65)mouths(range0.0–168.0mouths). The mean UPDRSē score of patients was(32.35±11.83) points and the median staging of H-Y scale was stage2.5(range stage 1.0-5.0). The incidence of motor fluctuations and dyskinesias was30.17%and17.24%,respectively. The motor fluctuations included wearing-off (21.55％)," on-off "phenomenon (5.17%), early morning akinesia (8.62%),"Delayed on"(3.45%),"noon"(2.59%) and freezing phenomenon(13.79%). The dyskinesias included Peak-dosedyskinesia (8.62％), Diphasic dyskinesia(1.72％) and dystonia (9.48％). Risk factorsfor motor fluctuations were initial treatment, dosage of daily levodopa and duration oflevodopa medication. Risk factor for dyskinesias was daily dose of L-dopa use.Conclusions:1. PD patients often present motor complications. The incidence of motorfluctuations and dyskinesias was30.17%and17.24%respectively. There weresignificant differences between patients with more than5years levodopa therapy andless than5years.2. Initial treatment with LD, higher daily levodopa dosage and longerduration of levodopa exposure may predispose to motor fluctuations and dyskinesias.3.When clinicians focus on alleviating motor symptoms, the awareness of motorcomplications is important. Less dose levodopa and adding other medications(dopamineagonists, MAO-B inhibitors, COMT inhibitors) may delay the presence of motorcomplications.