Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test
Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test
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DOI：
10.1016/j.parkreldis.2017.02.007
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发表时间：
2017-06-01
影响因子：
4.1
通讯作者：
Ferreira, Joaquim J.
中科院分区：
文献类型：
--
作者：
Fabbri, Margherita;Coelho, Miguel;Ferreira, Joaquim J.
背景：非运动症状（NMS）在晚期帕金森病（LSPD）患者中极为常见。左旋多巴（Levodopa，L-dopa）的反应性似乎随着疾病的进展而降低，但其对LSPD患者NMS的影响仍需研究。目的：评估L-dopa对LSPD患者血压、疼痛、疲劳和焦虑的反应。20例LSPD患者，定义为Schwab和England ADL量表3（MED ON），22例接受丘脑下深部脑刺激治疗的PD患者（晚期PD组）接受了左旋多巴激发。结果：LSPD患者服用左旋多巴后，收缩压明显下降（P < 0.05），而疼痛、疲劳和焦虑症状无明显变化。左旋多巴显著改善了晚期PD组的疼痛和焦虑（p < 0.05），但对血压和疲劳没有影响。左旋多巴相关的不良反应（AE），即OH和嗜睡，在LSPD患者中更常见。40%和65%的LSPD患者无法填写的VAS和STAI，分别，而直立位BP的测量是不可能在四个LSPD patients.Conclusions：这项探索性研究的结论是，一些非运动变量LSPD不受益于左旋多巴的急性作用，而它仍然可以诱导禁用AE。需要适合这些残疾LSPD患者的NMS评估工具。(C)2017爱思唯尔有限公司版权所有
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 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. (C) 2017 Elsevier Ltd. All rights reserved.