L-DOPA induced Dyskinesia in Parkinson s Disease Patients. Preliminary analysis from the French PARKMIP/COPARK cohort study after 24-months follow-up.

SANTIAGO PEREZ-LLORET; LAURENCE NEGRE-PAGES; OLIVIER RASCOL

Paris, Francia

Congreso; Congreso Internacional de Movimientos Anormales; 2009

Objective: To describe the prevalence, associated factors and progression of LID in thefirst 329 PD patients of the PARKMIP/COPARK cohort who reached the 24-months visit.Background: Levodopa-induced dyskinesia (LID) are common complications ofParkinson's Disease (PD) treatment.Methods: Inclusion criteria: ambulatory outpatients randomly selected by 28neurologists (general neurologists as well as movement disorders specialists), UKPDSBBdiagnostic criteria, MMSE>24, no deep brain stimulation.Data collection: demographics, UPDRS and Hoehn & Yahr, antiparkinsonian treatments,anxiety and depression symptoms (HADS) and quality of life (PDQ39). Presence of LIDwas defined as UPDRS IV 32 1.Statistical analysis: bivariate and logistic regression analysis.Results: Data could be analyzed in 280 (19 deceased patients and 30 patients withmissing data in the UPDRS). At baseline 71/280 (25%) of the patients exhibited LID.The main factors associated at baseline with LID presence were: longer PD duration(p<0.0002), younger age at onset (p<0.04), more severe UPDRS II+III score andHoehn&Yahr stage (p<0.0001 for both), greater anxiety (p=0.08) and depression scores(p<0.0001), longer duration of treatment (p<0.0001), higher levodopa daily dose(p<0.004), amantadine co-treatment (p<0.005) and worst PDQ39 scores (p<0.0003).Logistic regression showed that PD duration > 5 years and amantandine treatment wereindependently associated with LID (p<0.05 for all factors).After 24-month of follow-up, 85/280 patients (30%) had LID. 51/280 patients (18%)had a worsening in UPDRS IV 32 score. Such patients had greater UPDRS II+III scoreat baseline (p<0.03), longer levodopa exposure (p<0.05) and higher frequency ofdepression symptoms (p<0.02) and amantadine treatment (p<0.05). A multivariateanalysis disclosed that levodopa exposure > 3 years at baseline was the only variablesignificantly related to worsening of LID (OR= 2.5, [1.3-5.1]).Conclusions: In the PARKMIP/COPARK PD cohort, 25% of the patients exhibited LID atbaseline. After 2 years of follow-up 18% of the patients showed deterioration in LIDscore, which was associated with longer levodopa exposure at baseline.