Objective: This study aimed to analyze gait changes in Parkinson’s disease (PD) patients before and after levodopa administration, examining correlations between gait parameters and striatal dopamine transporter (DAT) availability measured via 18F-FP-CIT PET scans.

Background: Gait difficulty is a major source of disability in PD. Levodopa is the standard treatment for motor symptoms, including gait disturbances, but the specific gait parameters affected and the role of disease lateralization in treatment response remain unclear.

Method: A retrospective cohort study was conducted on 30 PD patients who underwent quantitative gait analysis using the GAITRite^® system before and after initiation of levodopa. Among these, 22 patients had valid standardized uptake value ratio (SUVR) measurements using PIMOD software. Patients were categorized into left-dominant (n=11) and right-dominant (n=11) PD based on DAT asymmetry in PET imaging. Paired t-tests were used to evaluate gait changes following levodopa administration. Subgroup analyses were performed to determine the impact of hemispheric lateralization on gait response.

Results: We identified specific key gait parameters that improve by levodopa such as velocity, cadence, step time, stance time and variability. (Table1) The extent of improvement varied by disease lateralization. Statistical analysis with paired t-test for key parameters of gait were conducted. Patients with greater DAT reduction in the left striatum (right-side dominant PD) showed significant increases in gait velocity (p=0.01) and cadence (p=0.005) post-levodopa, whereas those in the right striatum (left-side dominant PD) did not exhibit significant improvement on either parameter.(Figure1,2) There was no difference in severity of striatum involvement as measured in global uptake, asymmetry index, or most/least affected hemisphere in DAT scan SUVR value in left and right striatal-dominant PD groups, as well as cadence and velocity as measured by gait analysis.

Conclusion: This study highlights the differential effects of levodopa on gait in PD patients based on striatal lateralization. The findings emphasize the need for individualized treatment strategies and suggest that DAT imaging may help predict gait-related therapeutic responses in PD. Further research is needed to refine gait-based prognostic models.

Table 1

Figure 1

Figure 2

References: Webster, K. E., Wittwer, J. E., & Feller, J. A. (2005). Validity of the GAITRite® walkway system for the measurement of averaged and individual step parameters of gait. Gait & Posture, 22(4), 317–321. https://doi.org/10.1016/j.gaitpost.2004.10.005

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-impact-of-levodopa-on-gait-in-parkinsons-disease-a-quantitative-analysis-of-striatal-dopamine-transporter-availability-and-lateralization/