Risk Factors For Levodopa-Related Dyskinesias And Motor Fluctuations In Parkinson's Disease

Background:Although levodopa (LD) is the gold standard therapy for symptomatic treatment of Parkinson's disease (PD), the chronic use of LD leads to the development of motor complications in almost all patients. Several factors may account for the risk of developing levodopa-induced dyskinesias in patients with Parkinson disease.Objective:We assessed the presence and risk factors for motor complications in PD patients on LD therapy, discussion the potential pathogenesis and provide theory to the therapy and precaution.Methods and Patients:We performed a retrospective analysis of data from a randomized clinical trial. 97 patients with Parkinson disease were were enrolled in this study between June, 2008 and March,2010, information was assessed only in patients satisfying the following criteria:(1)clinical diagnosis of PD was based on UK PD Society Brain Bank diagnostic criteria; (2) duration of disease≥3 years; (3) Continuous L-dopa treatment for≥1 years; (4) no previous use or antipsychotics.62 subjects were available for further evaluations.A questionnaire was designed to assess the following variables:general information (age at onset of Parkinson's disease, gender, the age at onset of motor complications); living habit (tea, smoke); medicine (levodopa monodoses, daily levodopa doses, other antiparkinsonian drugs); duration (treatment delay, duration of levodopa therapy, duration of Parkinson's disease, duration of levodopa treatment); WOQ-9; Hoehn and Yahr; UPDRS(Ⅲ,Ⅳ).Statistical analysis was performed using the SPSS 13.0. We compared the variable by means of the two-sample t test and X2 test when appropriate. To assess the contribution of each individual variable on the appearance of motor complications, univariate and multivariate logistic regressions were performed. The estimated cumulative time-dependent probability of levodopa-induced dyskinesias occurrence since the onset of levodopa treatment was analyzed by Kaplan-Meier curves, The possible correlation of survival time curves with different variables was tested by using the logrank analysis.Results:Thirty five subjects (56.5%) developed motor complications and 27 (43.5%) did not. Of these,17 patients (27.5%) exhibited dyskinesias following levodopa administration,31 patients (50%) developed fluctuations and 13 patients (21%) developed both fluctuations and dyskinesias.Factors significantly associated with dyskinesia were earlier onset age of disease, tea drink and higher dose of levodopa. These factors were not associated with the motor fluctuations.Conclusions:Higher levodopa doses and habit of tea were associated with the occurrence of dyskinesias. No factor were associated with the motor fluctuations.