Levodopa Is a Double‐Edged Sword for Balance and Gait in People With Parkinson's Disease. Issue 10 (12th June 2015)

• Record Type: Journal Article
• Authors: Curtze, Carolin; Nutt, John G.; Carlson‐Kuhta, Patricia; Mancini, Martina; Horak, Fay B.
• Is Part Of: Movement disorders. Volume 30:Issue 10(2015)
• Page Start: 1361
• Page End: 1370
• Publication Date: 2015-06-12
• Subjects: Movement disorders -- Periodicals; 610
• DOI: 10.1002/mds.26269
• Languages: English
• ISSNs: 0885-3185

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="mds26176-sec-9101" sec-type="section"> <title>Background</title> <p>The effects of levodopa on balance and gait function in people with Parkinson's disease (PD) is controversial. This study compared the relative responsiveness to <sc>l</sc>‐dopa on six domains of balance and gait: postural sway in stance; gait pace; dynamic stability; gait initiation; arm swing; and turning in people with mild and severe PD, with and without dyskinesia.</p> </sec> <sec id="mds26176-sec-3101" sec-type="section"> <title>Methods</title> <p>We studied 104 subjects with idiopathic PD (H & Y II [n = 52] and III–IV [n = 52]) and 64 age‐matched controls. Subjects performed a mobility task in the practical <italic>off</italic> state and <italic>on</italic><sc>l</sc>‐dopa: standing quietly for 30 seconds, initiating gait, walking 7 meters, and turning 180 degrees. Thirty‐four measures of mobility were computed from inertial sensors. Standardized response means were used to determine relative responsiveness to <sc>l</sc>‐dopa.</p> </sec> <sec id="mds26176-sec-2101" sec-type="section"> <title>Results</title> <p>The largest improvements with <sc>l</sc>‐dopa were found for arm swing and pace‐related gait measures. Gait dynamic stability was unaffected by PD and not responsive to <sc>l</sc>‐dopa. <sc>l</sc>‐dopa reduced turning duration, but only in subjects with severe PD. In contrast to gait, postural sway in quiet standing increased with <sc>l</sc>‐dopa, especially in the more severely affected subjects. The increase in postural sway, as well as decrease in turning duration and exaggerated arm swing with <sc>l</sc>‐dopa was observed only for subjects with dyskinesia at the time of testing.</p> </sec> <sec id="mds26176-sec-0101" sec-type="section"> <title>Conclusions</title> <p>The observed spectrum of <sc>l</sc>‐dopa responsiveness in balance and gait measures suggests that multiple neural circuits control balance and gait. Many of the negative effects of <sc>l</sc>‐dopa may be directly or indirectly caused by dyskinesia. © 2015 International Parkinson and Movement Disorder Society</p> </sec> </abstract>