Clinical Responsiveness And Related Factors Of Acute Levodopa Challenge Test In Patients With Parkinson’s Disease

Objective:Analyze the improvement characteristics of different motor symptoms of PD patients with acute levodopa challenge test,further clarify the characteristics of levodopa response to different motor symptoms of PD patients,and play a guiding significance for the selection of individualized treatment strategies for PD patients;Analyze the correlation between the maximum improvement rate of MDS UPDRS-Ⅲ in acute levodopa challenge test and the improvement rate of different motor symptoms in 1 hour、2 hour、3 hour and 4 hour,and to provide the basis for rational use of MDS UPDRS-Ⅲ scale in acute levodopa challenge test;At present,the factors affecting levodopa response are still not clear.This study attempts to improve clinicians’ understanding of levodopa response in PD patients by analyzing the related factors affecting levodopa response.Methods:A total of 29 patients with idiopathic PD who were admitted to the Department of Neurology,the First Affiliated Hospital of Kunming Medical University from January 2019 to January 2021 were selected as the research subjects.Analyze the improvement of classic motor symptoms,axial symptoms and other symptoms in acute levodopa challenge test,and to observe the characteristics of the improvement rate of different motor symptoms.Appropriate statistical methods were used to analyze the correlation between the maximum improvement rate of MDS UPDRS-Ⅲ in the acute levodopa challenge test and the improvement rate of different motor symptoms at 1 hour、2 hour、3 hour and 4 hour.The subjects were grouped according to gender,onset side and motor subtype,and the differences of levodopa response among the groups were compared.Appropriate statistical methods were used to analyze the correlation between age,duration of disease,non-motor symptoms and levodopa response.P<0.05 indicates statistical significance,and the results are displayed in a list or graph.Results:1.The mean maximum improvement rate of MDS UPDRS-III in acute levodopa challenge test was 46.24%.In classic motor symptoms,the mean maximum improvement rate of rest tremor was 89.98%,and the mean minimum improvement rate of facial expression was 43.99%.Among the axial symptoms,the mean maximum improvement rate of freezing of gait was 85.23%,and the mean minimum improvement rate of neck rigidity was 33.85%.2.The difference in axial symptom scores between baseline and maximum improvement of acute levodopa challenge test in PD patients was statistically significant.Speech were improved by 44.38%,neck rigidity were improved by 33.85%,arising from chair were improved by 53.49%,gait were improved by 50.92%,freezing of gait were improved by 85.23%,posture stability were improved by 71.22%and posture were improved by 40.84%.3.During acute levodopa challenge test,different symptoms of the biggest improvement time points,classic motor symptoms,body spontaneous action 1 hour average period is the largest,facial expression,limbs rigidity and rest tremor in 2 hours,limbs bradykinesia in 3 hours,reached the maximum average period,Then the improvement rate decreases with time;The average improvement rate of rest tremor was the highest and the duration was the longest,the rest tremor still maintained a good improvement rate at 4 hours,the other motor symptoms showed obvious wearing-off.Among the axial symptoms,the average improvement rate of arising from chair and gait was the highest at 2 hours.The average improvement rate of speech,neck rigidity,freezing of gait,posture stability and posture was the highest at 3 hours,and then the improvement rate decreased with time.The average improvement rate of freezing of gait was the highest and the duration was the longest,the improvement rate of freezing of gait remained good at 4 hours,the other motor symptoms showed obvious wearing-off.4.Multiple linear regression model for the maximum improvement rate of MDS UPDRS-Ⅲ in the acute levodopa challenge test:The maximum improvement rate of MDS UPDRS-Ⅲ in the acute levodopa challenge test=0.144×2-hour improvement rate of systemic spontaneous movement+0.33 7×3-hour improvement rate of limbs bradykinesia+0.155×2-hour improvement rate of limbs rigidity+0.150×1-hour improvement rate of systemic spontaneous movement+21.6685.MDS UPDRS-Ⅲ Maximum Improvement Rate:①The maximum improvement rate of MDS UPDRS-Ⅲ was not correlated with age,duration of disease,and non-motor symptoms.②There was no significant difference in the maximum improvement rate of MDS UPDRS-Ⅲ between male and female patients.③There was no significant difference in the maximum improvement rate of MDS UPDRS-Ⅲ between TD and PIGD patients.④There was no significant difference in the maximum improvement rate of MDS UPDRS-Ⅲ between patients with right-onset and left-onset.6.MDS UPDRS-Ⅲ maximum improvement absolute value:①The maximum absolute value of MDS UPDRS-Ⅲ was not correlated with age,duration of disease and non-motor symptoms.②There was no significant difference in absolute maximum improvement of MDS UPDRS-Ⅲ between male and female patients.③There was no significant difference in absolute maximum improvement of MDS UPDRS-Ⅲ between patients with right-onset and patients with left-onset.④There was no significant difference in the absolute maximum improvement of MDS UPDRS-Ⅲ between TD and PIGD patients.7.Sum of improvement rates:①There was no correlation between the sum of improvement rates and age and non-motor symptoms.②The sum of improvement rate was related to the duration of disease(R=0.496).③There was no significant difference in the sum of improvement rates between male and female patients.③There was no significant difference in the sum of improvement rates between patients with right onset and patients with left onset.④There was no significant difference in the sum of improvement rates between TD and PIGD patients.8.Sum of absolute values of improvement:①There was no correlation between the sum of absolute value of improvement and age and non-motor symptoms.②The sum of absolute values of improvement was related to the duration of disease(R=0.501).③There was no significant difference in the sum of absolute values between male and female patients.③There was no significant difference in the sum of absolute values of improvement between patients with right-onset and left-onset.④There was no significant difference in the absolute sum of improvement between TD and PIGD patients.Conclusions:1.The classic motor symptoms and the arising from chair,gait and levodopa responsive freezing of gait,posture and postural stability in the axial symptoms of PD are levodopa responsive symptoms.2.The speech and neck rigidity of PD patients is responsive symptom of levodopa,but the speech and neck rigidity of some patients is aggravated after taking levodopa.3.The sum of the improvement rate and the sum of the absolute value of improvement were positively correlated with the duration of disease.