Objective: To assess the frequency of dyskinesias in a population based-cohort of Parkinson’s disease patients.

Background: Levodopa-induced dyskinesias are complications that may impact quality of life.

Methods: We utilized the 1991-2010 population-based, parkinsonism incident-cohort of Olmsted County, MN (N=669), accessed via the Rochester Epidemiology Project. From that parkinsonism cohort, we identified patients with Parkinson’s disease (PD) and abstracted information relating to levodopa-related dyskinesias.

Results: Of the 309 PD cases (46.2% of parkinsonisms), 279 (90.3%) were treated with levodopa. The vast majority (230/279; 82.4%) had been treated by a Mayo neurologist. Median age of levodopa initiation in this incidence cohort was 75 (range: 37-98 years) and duration of levodopa treatment was 6 years (range, 2 months to 19.8 years). Dyskinesias were documented in 30.1% (N=84). Among those with dyskinesias median time from levodopa-initiation to dyskinesias was 4 years (range: 2 months-20 years); 65.5% (55/84) developed dyskinesias within 5 years of levodopa initiation (9 within the first year of treatment). Dyskinesias were rated as mild in 57/84 (67.9%), moderate in 16/84 (19.1%) and severe in 9/84 (10.7%); dyskinesia severity was not reported in 2 cases. Dyskinesia severity led to levodopa adjustments (or amantadine) in 60.7% (51/84 of those with dyskinesias), with marked improvement in 23 (45.1%). All 13 dyskinetic patients that underwent deep brain stimulation (DBS) reported marked dyskinesia improvement. Post-mortem examination confirmed Lewy-body disease in all seven autopsied cases.

Conclusions: Levodopa-induced dyskinesias affected 30% of PD patients in our incident cohort. Mayo neurologists who favored optimized levodopa dosage treated most of the patients. Dyskinesias were severe in only 3% of all levodopa-treated PD patients (11% of all dyskinetic patients) with marked improvement among those treated with DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-induced-dyskinesias-in-parkinson-disease-a-population-based-cohort-study-in-olmsted-county-mn-1991-2010/