Dyskinesias and motor fluctuations in Parkinson's disease

TLDR

The study examined how common dyskinesias and motor fluctuations are in community‑based Parkinson’s patients and what factors predict them. Among 124 patients, 28 % of levodopa users had dyskinesias and 40 % had motor fluctuations; motor fluctuations were best predicted by disease duration and levodopa dose, while dyskinesias were predicted by levodopa duration, with younger age and earlier levodopa initiation accelerating complications, and higher medication response linked to more complications but lower quality of life in early and late disease stages.

Abstract

We investigated the prevalence of dyskinesias and motor fluctuations, and the factors determining their occurrence, in a community-based population of patients with Parkinson's disease. Among 124 patients with Parkinson's disease, 87 (70%) had received a levodopa preparation. Among these 87 patients, 28% were experiencing treatment-induced dyskinesias and 40% response fluctuations. The prevalence of motor fluctuations was best predicted by disease duration and dose of levodopa, whereas dyskinesias could be best predicted by duration of treatment. Patients with a shorter time from symptom onset to initiation of levodopa and younger patients had developed motor complications earlier, and patients who had started treatment with a dopamine agonist had developed these treatment complications later. Although a satisfactory response to medication was associated with higher rates of motor complications, poor or moderate response was associated with lower quality of life in patients with a disease duration of ≤5 years or ≥10 years. We conclude that motor fluctuations are most strongly related to disease duration and dose of levodopa, and dyskinesias to duration of levodopa treatment. However, poorer quality of life associated with inadequate dosage of levodopa may be the price for a low rate of motor complications in patients with Parkinson's disease.