THE IMPACT OF TREATMENT WITH LEVODOPA ON PARKINSONS-DISEASE

  • 1 January 1980
    • journal article
    • research article
    • Vol. 49  (195) , 283-293
Abstract
The progress of 178 patients with Parkinson''s disease who began treatment with L-dopa between Nov. 1969 and Dec. 1972 is reviewed after 6 yr. Patients (125) showed an initial improvement in their individual total disability scores exceeding 25% but after 6 yr of sustained treatment only 37 patients still obtained similar benefit. By 1978 only 5 patients had maintained their initial improvement compared to 69 patients after 2 yr therapy; 47 patients were still better than before treatment. The overall mortality ratio, the ratio of observed to expected death rate, for all the patients was 1.45:1. In those patients who were unable to tolerate L-dopa for longer than 2 yr, the ratio was 2.38:1; in those who were able to tolerate sustained medication, life expectancy was normal (ratio of 0.91:1 for males and 1.14:1 for females). Involuntary movements were the commonest complication of treatment. Three main types were distinguished. Peak dose dyskinesias, beginning 20-90 min after an oral dose and most severe midway through the inter-dose period, effected 80% of patients. Early morning and end-of-dose dystonia occurred in 20% of patients and biphasic dyskinesia, 2 distinct episodes of involuntary movements within each inter-dose period, was the least common pattern affecting 3% of patients. Involuntary movements increased in frequency and severity as treatment continued. End-of-dose deterioration (wearing-off effect of individual doses) occurred in 65% of patients: unpredictable oscillations in motor performance (the on-off phenomenon) unrelated to the time and dosage of L-dopa occurred in 10%. Psychiatric side effects included toxic confusional states, visual pseudohallucinations and paranoid psychoses and constituted the most frequent reason for stopping medication. Of the patients, 40 (22%) had suffered severe depression before the onset of disease and L-dopa had no sustained antidepressant effect in this group. After 6 yr of treatment with L-dopa, 32% of the patients had unequivocal dementia.