Objective:  

To evaluate possible associations between epidemiological and clinical data with risk of levodopa-induced dyskinesias (LID) onset in  Parkinson’s disease (PD) patients.

Background: LID are common complications in PD, but there are conflicting data about clinical risk factors associated with their onset.

Methods:  

A cross-sectional study was conducted with epidemiological and clinical data from Brazilian PD patients to identify clinical risk factors associated with LID onset. PD patients with levodopa therapy were submitted to neurological examination and semi-structured interviews performed by movement disorders specialists. Presence of LID was confirmed if UPDRS Part IV had a score ≥ 1 on item 32. Clinical phenotypes were defined based on the method described by Stebbins et al. (2013) as tremor dominant or postural instability/gait difficulty (PIGD). We performed multivariate logistic regression to identify clinical risk factors associated with LID onset.

Results: 198 Brazilian PD patients were enrolled (males – 59%; mean age 61.8 years). Of these patients, 96 (48.2%) presented LID. At a forward multivariate model with 7 independent variables (p < 0.1 in univariate analysis), tremor dominant phenotype showed a reduced risk of LID onset compared to PIGD patients (OR 0.17, CI95% 0.07-0.39; p < 0.001). Furthermore, longer duration (OR 1.31, CI95% 1.17-1.47; p < 0.001) and higher doses of levodopa therapy (OR 1.00, CI95% 1.000-1.002; p = 0.04), as also as early onset of PD (OR 1.04, CI95% 1.01-1.07; p = 0.009) increased risk of LID.

Conclusions: Together with previous studies, our results showed PD patients with tremor dominant clinical phenotype have a lower risk of LID onset, suggesting this phenotype present a more benign prognosis and a specific physiopathology.

References:  

1) Nicoletti A, Mostile G, Nicoletti G, Arabia G, Iliceto G, Lamberti P, Marconi R, Morgante L, Barone P, Quattrone A, Zappia M. Clinical phenotype and risk of levodopa-induced dyskinesia in Parkinson’s disease. J Neurol. 2016;263(5):888-94.

2) Zhang YH, Tang BS, Song CY, Xu Q, Lou MX, Liu ZH, Yu RH, Yan XX, Guo JF. The relationship between the phenotype of Parkinson’s disease and levodopa-induced dyskinesia. Neurosci Lett 2013, 556:109-12.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tremor-dominant-clinical-phenotype-is-associated-with-low-risk-of-levodopa-induced-dyskinesia-in-parkinsons-disease/