Objective: To identify the association between dyskinesia and related risk factors, the medication dosage range considered safe and treatment-related variables.To identify the association between dyskinesia and related risk factors, the medication dosage range considered safe and treatment-related variables.

Background: Currently, levodopa is a compensation for dopamine loss, remains the gold standard of treatment. However, with disease progression and longer exposure to levodopa, patients develop a range of motor complications, including dyskinesia that negatively impact quality of life and impose a significant economic burden. Several factors have been associated with the development of dyskinesia[1, 2]. However, the results from published studies have been inconsistent, and racial differences exist[3].

Method: We consecutively collected 1974 patients with parkinson’s disease(PD) during the period between February 2017 and June 2018 in different regions of Mainland China. Each patient was diagnosed with clinically established PD or clinically probable PD by at least two experienced neurologists according to International Parkinson and Movement Disorder Society (MDS) diagnostic criteria. All patients subsequently underwent extensive neurological assessments performed by experienced investigators in movement disorders who were specifically trained before the evaluation. PD patients with (n = 275) and without (n = 275) dyskinesia were stratified into 4 groups according to levodopa equivalent dose (LED). A prospective study of 87 patients with dyskinesia was classified into 3 groups according to the duration from onset of PD to the initiation of levodopa.

Results: Young age of onset, long disease duration, female, high LED, low UPDRS III scores (ON-state) and high Hoehn-Yahr stage (ON-state) were predictors of dyskinesia. Dyskinesia was levodopa dosage-dependent, and the incidence increased remarkably when LED exceeded 300 mg/d. The emergence of dyskinesia had no association with the initiation time of levodopa, and if the latter was more than 4 years, the duration of time on chronic levodopa free of motor complications was significantly shortened.

Conclusion: We found risk factors for the prediction of dyskinesia. Physicians should be cautious if the LED exceeds 300 mg/d. The development of dyskinesia was not correlated with the time of levodopa initiation.

References: 1. Bjornestad, A., E.B. Forsaa, K.F. Pedersen, O.B. Tysnes, J.P. Larsen, and G. Alves, Risk and course of motor complications in a population-based incident Parkinson’s disease cohort. Parkinsonism Relat Disord, 2016. 22: p. 48-53. 2. Zhang, Y.H., B.S. Tang, C.Y. Song, Q. Xu, M.X. Lou, Z.H. Liu, R.H. Yu, X.X. Yan, and J.F. Guo, The relationship between the phenotype of Parkinson’s disease and levodopa-induced dyskinesia. Neurosci Lett, 2013. 556: p. 109-12. 3. Cilia, R., A. Akpalu, F.S. Sarfo, M. Cham, M. Amboni, E. Cereda, M. Fabbri, P. Adjei, J. Akassi, A. Bonetti, and G. Pezzoli, The modern pre-levodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa. Brain, 2014. 137(Pt 10): p. 2731-42.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/factors-associated-with-dyskinesia-in-parkinsons-disease-in-mainland-china/