The Study Of Therapy And Motor Complications In Parkinson's Disease

Background:Parkinson 's disease(PD) is a common neurodegenerative disease and its clinical course, manifestation,drug use and complication varies. With the increase of the population age, the incidence rate showed an upward trend year after year, which give the family and the community a negative impact. Since Parkinson first described PD in 1817, the time in understanding of PD has been more than 190 years. Although the revere speculations that Chinese patients with PD had a later diagnosis, delayed use of L-dopa, and had less drug-induced complications, no published data support these claims. To characterize the features of clinical manifestation, pattern of drug use and drug-induced complications in Chinese PD patients will help us to better understand the guide of the diagnosis and treatment for PD patients.Objectives: The specific aims of this study in Suzhou PD patients is to investigate the clinical pattern of drug use, the incidence and associated risk factors for drug-induced motor complications.Methods: A retrospective clinical epidemiological method was applied in the study. Total 303 PD patients were enrolled from Suzhou. Data were collected through personal interview, ward and home follow-up by trained professional physician neurology.Results:①The pattern of drug use in general, patients began to use levodopa after 1.94 years of disease onset, while the earliest immediately, and the latest after 16 years at disease onset. The time interval between disease onset and drug use was shorter in female than in male, wich is 1.73 years vs 2.11 years. The most common drug combination was levodopa plus dopamine agonists or selegiline. With the development of disease, the dosage increase slowly, while the dosage increase rapidly when course of disease more than 8 years. The mean daily dosage of levodopa was 326.19mg at 4～6 years after drug treatment.②The incidence for motor complications: Among 261 patients, 41 (15.71%) patients experienced dyskinesias and 117(44.83%) patients had motor fluctuation, and 32(12.26%)experienced both for. The dyskinesia incidence was 1.41%,14.29%,and 47.62% for patients with L-dopa treatment less than 2 years, 4-6 years and beyond 8 years, respectively. In parallel, the incidence of motor fluctuation was 22.54%, 47.62%, and 73.81%.③Tape for motor complications: The main subtype of motor fluctuation was wearing-off and that of dyskinesias was dystonia. Chorea and"on-off"was few while no billism and myoclonus were found.④Associated risk factors for motor complications: Logistic regression analysis showed that onset age, start drug, treatment time, disease duration and accumulative drug dose were related to the development of motor complications. Single-factor statistical analysis showed that course of disease (5-8 years OR = 2.477;> 8 years OR = 5.853), total dose of levodopa (> 2000mg OR = 3.028), L-dopa daily dose (> 500mg OR = 2.853), H-Y stages (4 and above OR = 14.618), UPDRS-on score (≧ 30 minutes OR = 3.094) was positively correlated with motor fluctuation; with Schwab score (OR = 0.043) negative correlation. The duration (> 8 years OR = 16.988), total dose of levodopa (> 2000mg OR = 45.204), L-dopa daily dose (> 500mg OR = 13.128), H-Y stages (4 and above OR = 8.211) was positively correlated with dyskinesias; and Schwab score (OR = 0.097) was negatively correlated with dyskinesias. Multi-factor statistical analysis showed that course of disease (5-8 years OR = 1.959;> 8 years OR = 4.385) was positively correlated with motor fluctuation; with Schwab score (OR = 0.080) negative correlation. The total dose of levodopa (> 2000mg OR = 63.043) were positively correlated with dyskinesias; with male gender (OR = 0.399) negative correlation.Conclusion:①There is a great heterogeneity in clinical features and prognosis among the Chinese PD patients. The female patients are more likely to use levodopa earlier as compared to male patients. Levodopa plus dopamine agonists or selegiline is the most common combination of drug use and Levodopa is the most effective drug. However, the drug dosage is much lower in Chinese patients than that reported for Western PD patients.②The incidence of L-dopa-induced dyskinesia was lower in Suzhou patients as compared to Western PD patients but the motor fluctuation incidence was similar. The incidence of motor complications is associated with drug dosage, time of drug use and disease duration.