Objective: To identify the factors associated with the occurrence of motor complications among patients with Parkinson’s disease (PD) who receive levodopa treatment.

Background:  Levodopa is the most effective therapy in PD, however, side-effects, such as dyskinesias and motor fluctuations may occur after some years of usage.

Methods: In a cross-sectional study carried out in 2010-2016, clinical data and treatment details were collected. Among clinimetric scales, the Movement Disorders Society Unified Parkinson´s Disease Rating Scale (MDS-UPDRS), the Beck Depression Inventory (BDI), and the Parkinson´s Disease Questionnaire (PDQ-39) were used. Logistic regression expressed by odd ratio (OR) and confidence intervals (CI) was conducted to identify the effects of several predictor variables on the emergence of motor complications.

Results: A total of 455 PD patients with the average age of 73.7 years and the average disease duration of 6.9 years, were enrolled in the study. Out of the total cohort of our study, altogether 82.2% (374/455) of patients were at the time of investigation on levodopa therapy. Levodopa treatment was initiated on average 2.7 years after PD diagnosis. The average of the daily levodopa dose and the levodopa equivalent daily dose (LEDD) were 424 mg and 471 mg, respectively. 87 patients had motor complications. Out of them, 60% of patients experienced both types of the motor complications – dyskinesias and motor fluctuations. Significant factors predictive for motor complications were: younger age at onset of the disease (OR 0.83; 95% CI 0.758-0.901), higher LEDD (OR 1.003; 95% CI 1.001-1.004), older age (OR 1.12; 95% CI 1.033-1.225), shorter time from the  initial PD symptoms until the initiation of the levodopa treatment  (OR 0.796; 95% CI 0.628-0.967), and hypokinetic-rigid dominant subtype of PD (OR 2.41; 95% CI 1.021-5.808), compared to tremor-dominant subtype.

Conclusions: This study suggests that postponing the start of levodopa therapy and maintaining low daily doses of levodopa might reduce the risk of motor complications. Our results confirm that due to the higher risk for motor complications, achieving effective treatment results in patients with hypokinetic-rigid dominant subtype of PD might be more challenging than in patients with tremor-dominant subtype of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/factors-associated-with-occurrence-of-motor-complications-among-parkinsons-disease-patients-with-levodopa-treatment-in-estonia/