Cervantes-Arriaga A, Rodríguez-Violante M, Yescas P, Alonso-Vilatela E

Language: Spanish
References: 20
Page: 141-146
PDF size: 131.16 Kb.

ABSTRACT

Background: motor fluctuations induced by dopamine replacement therapy are among the main complications of the treatment of patients with Parkinson’s disease. Our objective was to determine the incidence of motor fluctuations in a retrospective cohort of Mexican patients with Parkinson’s disease.
Methods: we reviewed the files of 584 cases of Parkinson’s disease patients treated at the National Institute of Neurology and Neurosurgery between 1990 and 2010. We registered the demographic and clinical data to analyze the disease course.
Results: the follow-up was of 4736 person-years. 33.9% of patients (n = 198) had motor fluctuations at some point in the evolution of the disease. The rate of person-time incidence was 43 cases per 1000 person-years. The daily dose of levodopa equivalents greater than 600 mg/d and the use of levodopa were the main risk factors for early development of motor fluctuations (HR 1.40 [95 % CI = 1.07 to 1.83, p ‹ 0.001] and HR 1.61 [95 % CI = 1.17 to 2.23, p = 0.004], respectively).
Conclusions: the main determinants of early development of motor fluctuations are the levodopa equivalent daily dose and the quantity and early use of levodopa.

REFERENCES

1. Alves G, Forsaa EB, Pedersen KF, Dreetz Gjerstad M, Larsen JP. Epidemiology of Parkinson’s disease. J Neurol 2008;255(Suppl 5):18-32.

2. Hely MA, Morris JGL, Reid WGJ, Trafficante R. Sydney multicenter study of Parkinson’s disease: non L-dopa-responsive problems dominate at 15 years. Mov Disord 2002;20(2):190-99.

3. Fox SH, Lang AE. Levodopara-related motor complications. Phnomenology. Mov Disord 2008;23(Suppl 3): S509- S515.

4. Rinne UK, Bracco F, Chouza C, Dupont E, Gershanik O, Marti Masso JF, et al. Early treatment of Parkinson’s disease with cabergoline delays the onset of motor complications. Results of a double blind levodopa controlled trial. The PKDS009 Study Group. Drugs 1998;55(Suppl 1):23-30.

5. Miyasaki JM. Evidence-based initiation of dopaminergic therapy in Parkinson’s disease. J Neurol 2010;257(Suppl 2): S309- S313.

6. Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson´s disease: A randomized controlled trial. JAMA 2000;284(15):1931-1938.

7. Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 1988;51(6):745-752. Disponible en http://jnnp.bmj.com/content/51/6/745.long

8. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967;17(5):427-442.

9. Papaetropoulos S, Mash DC. Motor fluctuations and dyskinesias in advanced/end stage Parkinsons’s disease. A study from a population of brain donors. J Neural Transm 2007;114(3);341-345.

10. Widnell K. Pathophysiology of motor fluctuations in Parkinson’s disease. Mov Disord 2005;20(Suppl 1):S17-S22.

11. Nutt JG. Motor fluctuations and dyskinesia in Parkinson’s disease. Parkinsonism Relat Disord 2001;8(2):101-108.

12. López IC, Ruiz PJ, del Pozo SV, Bernardos VS. Motor complications in Parkinson’s disease: Ten year follow-up study. Mov Disord 2010;25(16):2735-2739.

13. Denny AP, Behari M. Motor fluctuations in Parkinson’s disease. J Neurol Sci 1999;165(1):18-23.

14. Grandas P, Luquin MR, Rodríguez M, Vaamonde J, Lera G, Obeso JA. Motor fluctuations in Parkinson disease. Risk factors. Neurologia 1992;7(5):89-93.

15. Schrag A, Quinn N. Dyskinesia and motor fluctuations in Parkinson’s disease: a community based study. Brain 2000; 123(Pt 11):2297-2305.

16. Caraceni T, Scigliano G, Musicco M. The occurrence of motor fluctuations in parkinsonian patients treated long term with levodopa: role of early treatment and disease progression. Neurology 1991;41(3):380-384.

17. Hauser RA, McDermott MP, Messing S. Factors associated with the development of motor fluctuations and dyskinesias in Parkinson disease. Arch Neurol 2006;63(12): 1756-1760.

18. 18 Kum WF, Gao J, Durairajan SS, Man SC, Xie LX, Lu JH, et al. Risk factors in development of motor complications in Chinese patients with idiopathic Parkinson’s disease. J Clin Neurosci 2009;16(8):1034-1037.

19. Parkinson Study Group. A randomized controlled trial comparing pramipexole with levodopa in early Parkinson’s disease: design and methods of the CALM-PD Study. Clin Neuropharmacol 2000;23(1):34-44.

20. Jankovic J, Stacy M. Medical management of levodopa-associated motor complications in patients with Parkinson’s disease. CNS Drugs 2007;21(8):677-692.