Severe dyskinesias rare in community Parkinson’s cohort

By Eleanor McDermid, Senior medwireNews Reporter

Motor fluctuations and dyskinesias affect about a third of community-based patients with Parkinson’s disease (PD), but dyskinesias are rarely severe enough to warrant a change of treatment, report researchers.

Angus Macleod (University of Aberdeen, UK) and team followed up 183 community-based PD patients for an average of 59 months after they started dopaminergic treatment. During this time 21.3% developed motor fluctuations, giving a 5-year rate of 29.2%.

Of the patients who developed motor fluctuations, 64.1% (13.7% of all patients) had them severely enough to require a change of treatment, usually in the form of more frequent dosing or additional controlled-release levodopa at night.

Dyskinesias occurred in 28.4% of patients, after a median dyskinesia-free period of 85 months. The 5-year rate of dyskinesias was 37.0%, and these were sufficiently severe to prompt a change of treatment in 15.4% (4.4% of the whole cohort).

Twenty-three (12.6%) patients developed both motor fluctuations and dyskinesias, with 14 of these patients developing dyskinesias first.

In line with expectations, higher cumulative levodopa dose significantly predicted an increased risk of both motor fluctuations and dyskinesias. Being female was also a significant predictor of both outcomes, and younger age at diagnosis was associated with a higher risk of motor fluctuations.

Secondary analyses also suggested that tremor at diagnosis could be associated with an increased risk of motor fluctuations and dyskinesias, and moderate, but not high, lifetime caffeine intake might be protective against motor fluctuations.

“Further work with more patients with longer follow-up would be useful for more detailed analysis of risk factors”, writes the team in the European Journal of Neurology. “Individual-patient-data meta-analysis of existing representative studies would be an efficient way to do this.”

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