Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test. (June 2017)

• Record Type: Journal Article
• Authors: Fabbri, Margherita; Coelho, Miguel; Guedes, Leonor Correia; Chendo, Ines; Sousa, Catarina; Rosa, Mario M.; Abreu, Daisy; Costa, Nilza; Godinho, Catarina; Antonini, Angelo; Ferreira, Joaquim J.
• Is Part Of: Parkinsonism & related disorders. Volume 39(2017)
• Page Start: 37
• Page End: 43
• Publication Date: 2017-06
• Subjects: Parkinson's disease -- Late-stage -- Levodopa -- Non-motor symptoms; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2017.02.007
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: Non-motor symptoms (NMS) are extremely common among late-stage Parkinson's disease (LSPD) patients. Levodopa (L-dopa) responsiveness seems to decrease with disease progression but its effect on NMS in LSPD still needs to be investigated. Objective: To assess the response of blood pressure (BP), pain, fatigue and anxiety to L-dopa in LSPD patients. Methods: 20 LSPD patients, defined as Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 (MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (advanced PD group) underwent an L-dopa challenge. BP and orthostatic hypotension (OH) assessment, a visual analogue scale (VAS) for pain and fatigue and the Strait Trait Anxiety (STAI) were evaluated before and after the L-dopa challenge. Results: Systolic BP dropped significantly after L-dopa intake (p < 0.05) in LSPD patients, while there was no change in pain, fatigue or anxiety. L-dopa significantly improved (p < 0.05) pain and anxiety in the advanced PD group, whereas it had no effect on BP or fatigue. L-dopa-related adverse effects (AEs), namely OH and sleepiness, were more common among LSPD patients. 40% and 65% of LSPD patients were not able to fill out the VAS and the STAI, respectively, while measurement of orthostatic BP was not possible in four LSPD patients. Conclusions: This exploratory study concludes that some non-motor variables in LSPD do not benefit from the acute action of L-dopa while it can still induce disabling AEs. There is a need for assessment tools of NMS adapted to these disabled LSPD patients. Highlights: 70% of PD patients in late stage with a disease duration of 14 years are demented. Other non-motor symptoms are highly frequent and severe. A levodopa challenge causes significant drop in systolic blood pressure. Fatigue, pain and anxiety do not benefit with a levodopa challenge. A third develops drowsiness after a levodopa challenge.