CLINICAL FEATURES OF LEVODOPA-INDUCED DYSKINESIA IN PATIENTS WITH PARKINSON’S DISEASE

In Parkinson's disease, one of the most troublesome dillemas is the treatment of levodopa-induced dyskinesia.The time-to-onset and severity of this motor complication show large variability according to disease duration, long-term use of levodopa and other factors.PD patients were enrolled to study based on UK brain bank diagnostic criteria and underwent examination on motor evaluation with help of UPDRS part III and presence of dyskinesia by UPDRS IV, to assess the severity of disease based on modified Hoehn and Yahr Scale.Considering the motor symptoms at onset, PD patients were divided into three subgroups: tremor-dominant, akinetic-rigid and mixed type.208 patients (105 men) were recruited in the study of who had advanced stage of PD. 105 (50,4%) were classified as tremor-dominant, 87 (41,9%) as akinetic-rigid and 16 (7,7%) as mixed type.Patients in the tremor -dominant subtype were somewhat older (p=0,027).Approximately all patients were treated with L-dopa and 81,2% were in combination with dopamine agonist.Almost half patients received treatment with amantadine.In terms of disease duration and developing of wearing off , there was significantly difference according to clinical phenotype.AR and mix subtype of PD develop wearing off earlier within 3 years compare to TD ( P<0,05).72,4% TD type develop wearing off after 6 years and further while AR and Mix type develop earlier.(OR was 0.43; 95 % CI 0.24-0.89,RR was 0,69).It should be also noted that when gender was included in the analysis we didn't found a positive association with wearing off as well as LID (wearing off= OR was 0,78; 95% CI 0,43-1.41;p value 0,45; LID= OR was 0.73; 95 % CI 0.42-1.26;RR=0,85, p value 0.27).Dyskinesias were predominantly peak dose in 64%.The same no association with average LED with LID (p=0,26).We may conclude that tremor dominant type of PD may predict slower progression of LID.