BACKGROUND: The effects of levodopa on balance and gait function in people with Parkinson's disease (PD) is controversial. This study compared the relative responsiveness to l-dopa on six domains of balance and gait: postural sway in stance; gait pace; dynamic stability; gait initiation; arm swing; and turning in people with mild and severe PD, with and without dyskinesia. METHODS: We studied 104 subjects with idiopathic PD (H & Y II [n = 52] and III-IV [n = 52]) and 64 age-matched controls. Subjects performed a mobility task in the practical off state and on l-dopa: standing quietly for 30 seconds, initiating gait, walking 7 meters, and turning 180 degrees. Thirty-four measures of mobility were computed from inertial sensors. Standardized response means were used to determine relative responsiveness to l-dopa. RESULTS: The largest improvements with l-dopa were found for arm swing and pace-related gait measures. Gait dynamic stability was unaffected by PD and not responsive to l-dopa. l-dopa reduced turning duration, but only in subjects with severe PD. In contrast to gait, postural sway in quiet standing increased with l-dopa, especially in the more severely affected subjects. The increase in postural sway, as well as decrease in turning duration and exaggerated arm swing with l-dopa was observed only for subjects with dyskinesia at the time of testing. CONCLUSIONS: The observed spectrum of l-dopa responsiveness in balance and gait measures suggests that multiple neural circuits control balance and gait. Many of the negative effects of l-dopa may be directly or indirectly caused by dyskinesia.
BACKGROUND: The effects of levodopa on balance and gait function in people with Parkinson's disease (PD) is controversial. This study compared the relative responsiveness to l-dopa on six domains of balance and gait: postural sway in stance; gait pace; dynamic stability; gait initiation; arm swing; and turning in people with mild and severe PD, with and without dyskinesia. METHODS: We studied 104 subjects with idiopathic PD (H & Y II [n = 52] and III-IV [n = 52]) and 64 age-matched controls. Subjects performed a mobility task in the practical off state and on l-dopa: standing quietly for 30 seconds, initiating gait, walking 7 meters, and turning 180 degrees. Thirty-four measures of mobility were computed from inertial sensors. Standardized response means were used to determine relative responsiveness to l-dopa. RESULTS: The largest improvements with l-dopa were found for arm swing and pace-related gait measures. Gait dynamic stability was unaffected by PD and not responsive to l-dopa. l-dopa reduced turning duration, but only in subjects with severe PD. In contrast to gait, postural sway in quiet standing increased with l-dopa, especially in the more severely affected subjects. The increase in postural sway, as well as decrease in turning duration and exaggerated arm swing with l-dopa was observed only for subjects with dyskinesia at the time of testing. CONCLUSIONS: The observed spectrum of l-dopa responsiveness in balance and gait measures suggests that multiple neural circuits control balance and gait. Many of the negative effects of l-dopa may be directly or indirectly caused by dyskinesia.
Authors: Kenneth A Follett; Frances M Weaver; Matthew Stern; Kwan Hur; Crystal L Harris; Ping Luo; William J Marks; Johannes Rothlind; Oren Sagher; Claudia Moy; Rajesh Pahwa; Kim Burchiel; Penelope Hogarth; Eugene C Lai; John E Duda; Kathryn Holloway; Ali Samii; Stacy Horn; Jeff M Bronstein; Gatana Stoner; Philip A Starr; Richard Simpson; Gordon Baltuch; Antonio De Salles; Grant D Huang; Domenic J Reda Journal: N Engl J Med Date: 2010-06-03 Impact factor: 91.245
Authors: Ana Claudia de Souza Fortaleza; Martina Mancini; Patty Carlson-Kuhta; Laurie A King; John G Nutt; Eliane Ferrari Chagas; Ismael Forte Freitas; Fay B Horak Journal: Gait Posture Date: 2017-05-10 Impact factor: 2.840
Authors: Franz Marxreiter; Heiko Gaßner; Olga Borozdina; Jens Barth; Zacharias Kohl; Johannes C M Schlachetzki; Caroline Thun-Hohenstein; Dieter Volc; Bjoern M Eskofier; Jürgen Winkler; Jochen Klucken Journal: J Neurol Date: 2018-09-08 Impact factor: 4.849
Authors: Edward P Washabaugh; Tarun Kalyanaraman; Peter G Adamczyk; Edward S Claflin; Chandramouli Krishnan Journal: Gait Posture Date: 2017-04-12 Impact factor: 2.840
Authors: Katrijn Smulders; Marian L Dale; Patricia Carlson-Kuhta; John G Nutt; Fay B Horak Journal: Parkinsonism Relat Disord Date: 2016-07-17 Impact factor: 4.891