Margherita Fabbri1, Miguel Coelho2, Leonor Correia Guedes2, Ines Chendo3, Catarina Sousa4, Mario M Rosa5, Daisy Abreu1, Nilza Costa1, Catarina Godinho6, Angelo Antonini7, Joaquim J Ferreira8. 1. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal. 2. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal. 3. Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal. 4. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal. 5. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal. 6. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal; Center for Interdisciplinary Research Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal. 7. Fondazione Ospedale San Camillo-I.R.C.C.S., Parkinson and Movement Disorders Unit, Venice, Italy; Department of Neurosciences (DNS), Padova University, Padova, Italy. 8. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal. Electronic address: joaquimjferreira@gmail.com.
Abstract
BACKGROUND: Non-motor symptoms (NMS) are extremely common among late-stage Parkinson's disease (LSPD) patients. Levodopa (L-dopa) responsiveness seems to decrease with disease progression but its effect on NMS in LSPD still needs to be investigated. OBJECTIVE: To assess the response of blood pressure (BP), pain, fatigue and anxiety to L-dopa in LSPD patients. METHODS: 20 LSPD patients, defined as Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 (MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (advanced PD group) underwent an L-dopa challenge. BP and orthostatic hypotension (OH) assessment, a visual analogue scale (VAS) for pain and fatigue and the Strait Trait Anxiety (STAI) were evaluated before and after the L-dopa challenge. RESULTS: Systolic BP dropped significantly after L-dopa intake (p < 0.05) in LSPD patients, while there was no change in pain, fatigue or anxiety. L-dopa significantly improved (p < 0.05) pain and anxiety in the advanced PD group, whereas it had no effect on BP or fatigue. L-dopa-related adverse effects (AEs), namely OH and sleepiness, were more common among LSPD patients. 40% and 65% of LSPD patients were not able to fill out the VAS and the STAI, respectively, while measurement of orthostatic BP was not possible in four LSPD patients. CONCLUSIONS: This exploratory study concludes that some non-motor variables in LSPD do not benefit from the acute action of L-dopa while it can still induce disabling AEs. There is a need for assessment tools of NMS adapted to these disabled LSPD patients.
BACKGROUND: Non-motor symptoms (NMS) are extremely common among late-stage Parkinson's disease (LSPD) patients. Levodopa (L-dopa) responsiveness seems to decrease with disease progression but its effect on NMS in LSPD still needs to be investigated. OBJECTIVE: To assess the response of blood pressure (BP), pain, fatigue and anxiety to L-dopa in LSPD patients. METHODS: 20 LSPD patients, defined as Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 (MED ON) and 22 PDpatients treated with subthalamic deep brain stimulation (advanced PD group) underwent an L-dopa challenge. BP and orthostatic hypotension (OH) assessment, a visual analogue scale (VAS) for pain and fatigue and the Strait Trait Anxiety (STAI) were evaluated before and after the L-dopa challenge. RESULTS: Systolic BP dropped significantly after L-dopa intake (p < 0.05) in LSPD patients, while there was no change in pain, fatigue or anxiety. L-dopa significantly improved (p < 0.05) pain and anxiety in the advanced PD group, whereas it had no effect on BP or fatigue. L-dopa-related adverse effects (AEs), namely OH and sleepiness, were more common among LSPD patients. 40% and 65% of LSPD patients were not able to fill out the VAS and the STAI, respectively, while measurement of orthostatic BP was not possible in four LSPD patients. CONCLUSIONS: This exploratory study concludes that some non-motor variables in LSPD do not benefit from the acute action of L-dopa while it can still induce disabling AEs. There is a need for assessment tools of NMS adapted to these disabled LSPD patients.
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