Objective: To characterize subjective clinical complaints reported by patients with Parkinson’s Disease (PD) following levodopa administration and evaluate the utility of the levodopa challenge test (LCT) in clarifying these symptoms.

Background: A substantial proportion of the population resides in resource-limited settings. In these populations, low health literacy is prevalent and can significantly influence symptom reporting and medication adherence [1]. Certain subjective clinical complaints may not be elucidated through clinical history alone, necessitating objective measures to determine their temporal association with levodopa. The LCT may be a potentially valuable tool for clarifying these ambiguous complaints [2].

Method: This retrospective case series included 23 patients diagnosed with PD  adhering to the Movement Disorder Society (MDS) clinical diagnostic criteria. Patients were selected based on the presence of clinical complaints following levodopa use that were either not readily explained by clinical history or exhibited an uncertain relationship to levodopa administration. Participants underwent washout period of their Parkinson’s medications to induce an OFF-state. Baseline clinical symptom assessments were performed, followed by the administration of the patient’s morning dose of dispersible levodopa. Subsequent clinical assessments were conducted in the ON-state. Symptoms observed during the transition from the OFF-state to the ON-state were also  documented.

Results: The majority of participants were male (13/23), with a median age of 54 years (range: 28-81) and a median disease duration of 10-15 years. The most frequently  complaints were motor fluctuations and dyskinesias. Notably, some patients who reported no subjective response to levodopa exhibited objectively demonstrable clinical responses during the challenge test. Complex dyskinesias, such as ON-state dystonia exacerbating gait, were also observed.

Conclusion: Our observations revealed discrepancies between patients’ subjective reports of levodopa response and objective  findings. Further research is warranted to elucidate the factors contributing to these discrepancies, including the  impact of low health literacy. We conclude that the levodopa challenge test is a potentially valuable tool for identifying atypical motor fluctuations.

References: 1 – Coughlin SS, Vernon M, Hatzigeorgiou C, George V. Health Literacy, Social Determinants of Health, and Disease Prevention and Control. J Environ Health Sci. 2020;6(1):3061. Epub 2020 Dec 16. PMID: 33604453; PMCID: PMC7889072.
2 – Saranza G, Lang AE. Levodopa challenge test: indications, protocol, and guide. J Neurol. 2021 Sep;268(9):3135-3143. doi: 10.1007/s00415-020-09810-7. Epub 2020 Apr 24. PMID: 32333167

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MDS Abstracts - https://www.mdsabstracts.org/abstract/utilizing-the-levodopa-challenge-test-to-clarify-clinical-complaints-following-levodopa-administration-a-case-series/