J Mov Disord.  2019 Jan;12(1):37-42. 10.14802/jmd.18046.

Less Pulsatile Levodopa Therapy (6 Doses Daily) Is Associated with a Reduced Incidence of Dyskinesia

Affiliations
  • 1Department of Neurology, Medstar Washington Hospital Center, Medstar Georgetown University Hospital and Georgetown University School of Medicine, Washington, DC, USA. mark.m.lin@medstar.net

Abstract


OBJECTIVE
To evaluate whether less pulsatile levodopa therapy (LPT) can reduce the development of levodopa-induced dyskinesia (LID).
METHODS
This is a retrospective cohort study of patients with Parkinson's disease at the movement disorders clinic of Medstar Washington Hospital Center. The study was not blinded or randomized. Patients were seen between August 2002 and August 2018. During these years, we treated patients with less pulsatile (6 doses daily) levodopa treatment to reduce LID. Occurrence of LID was recorded.
RESULTS
Ninety-five patients with Parkinson's disease taking levodopa were divided into two groups: 1) patients who were initially managed on LPT or who switched from traditional therapy (TT) (n = 61) (mean disease duration: 7.7 ± 4.8 years, mean levodopa duration: 5.6 ± 4.5 years and mean observation time: 4.3 ± 3.4 years), and 2) patients on TT throughout the observation period or until they developed dyskinesia (n = 34) (mean disease duration: 8.3 ± 3.8 years, mean levodopa duration: 6.2 ± 4.2 years and mean observation time: 4.1 ± 3.4 years). Three of the 61 LPT patients developed dyskinesia during the observation period. One of the patients developed dyskinesia after being switched to pulsatile doses by another doctor. In the other two, dyskinesia was minimal. In contrast to this 4.9% cumulative incidence, dyskinesia occurred in 50% (17/34) of TT patients, an incidence similar to that in published data (p < 0.001).
CONCLUSION
Less pulsatile levodopa with 6 daily doses was associated with a low incidence of LID. Further study of this method of treatment is warranted.

Keyword

Parkinson disease; levodopa; less pulsatile levodopa therapy; continuous dopaminergic stimulation; levodopa-induced dyskinesia

MeSH Terms

Cohort Studies
Dyskinesias*
Humans
Incidence*
Levodopa*
Methods
Movement Disorders
Parkinson Disease
Retrospective Studies
Washington
Levodopa
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