Levodopa, Methylmalonic Acid, and Neuropathy in Idiopathic Parkinson Disease
Levodopa, Methylmalonic Acid, and Neuropathy in Idiopathic Parkinson Disease
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DOI：
10.1002/ana.22021
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发表时间：
2010-07-01
影响因子：
11.2
通讯作者：
Suchowersky, Oksana
中科院分区：
文献类型：
--
作者：
Toth, Cory;Breithaupt, Kim;Suchowersky, Oksana
目的：周围神经病变（PN）被认为与特发性帕金森病（IPD）患者同时发生。我们试图检查 IPD 患者群体中 PN 的患病率以及与左旋多巴使用和空腹甲基丙二酸 (MMA) 水平的潜在关系。方法：在一项前瞻性队列研究中，使用临床和电生理学测量，对从综合数据库中随机选择的 IPD 患者与对照受试者进行 PN 的存在和严重程度的比较。 IPD 严重程度使用统一帕金森病评定量表 (UPDRS) 确定。我们确定了左旋多巴的使用与钴胺素、MMA 和同型半胱氨酸的血清水平的关系 (Hey)。我们还探讨了 PN 的存在和严重程度与年龄、IPD 持续时间、左旋多巴累积剂量、钴胺素、MMA 和 Hcy 水平之间的关联。结果：将 58 名随机选择的 IPD 患者与 58 名年龄和性别匹配的对照进行比较。 55% 的 IPD 患者和 9% 的对照组存在 PN。 IPD 患者的 PN 患病率和空腹 MMA/Hcy 水平高于对照组。合并 PN 的 IPD 患者年龄较大，且表现出较高的 UPDRS 评分、空腹 MMA/Hcy 水平和累积左旋多巴暴露量。 IPD 受试者的 PN 严重程度与左旋多巴暴露量和 MMA 水平呈正相关。解释：IPD 患者的 PN 患病率高于对照组。尽管因果关系尚未确定，但左旋多巴暴露与 IPD 患者的 MMA 升高和感觉运动神经病变相关。应考虑与左旋多巴治疗同时进行钴胺素替代治疗，以防止 IPD 患者发生 PN。安神经学 2010；67:28-36
Objective: Peripheral neuropathy (PN) is thought to be coincidental in patients with idiopathic Parkinson disease (IPD). We sought to examine the prevalence of PN in a population of IPD patients and a potential relationship to levodopa use and fasting methylmalonic acid (MMA) levels.Methods: In a prospective cohort study, IPD patients randomly selected from a comprehensive database were compared to control subjects regarding the presence and severity of PN using clinical and electrophysiological measures. IPD severity was determined using the Unified Parkinson's Disease Rating Scale (UPDRS). We determined the relation of levodopa use with serum levels of cobalamin, MMA, and homocysteine (Hey). We also explored the association between presence and severity of PN and age, duration of IPD, cumulative levodopa dosing, cobalamin, MMA, and Hcy levels.Results: Fifty-eight randomly selected IPD patients were compared to 58 age- and sex-matched controls. PN was present in 55% of IPD patients and 9% of controls. Patients with IPD had greater prevalence of PN and fasting MMA/Hcy levels than controls. IPD patients with PN were older and exhibited higher UPDRS scores, fasting MMA/Hcy levels, and cumulative levodopa exposure. PN severity in IPD subjects positively correlated with both levodopa exposure and MMA levels.Interpretation: IPD patients have a higher prevalence of PN than controls. Although causality is not established, levodopa exposure is associated with MMA elevation and sensorimotor neuropathy in IPD patients. Cobalamin replacement concurrent with levodopa therapy should be considered to protect against development of PN in IPD patients. ANN NEUROL 2010;67:28-36