Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;268(7):2506-2514.
doi: 10.1007/s00415-021-10419-7. Epub 2021 Feb 5.

Effects of Levodopa on quality of sleep and nocturnal movements in Parkinson's Disease

Eva Schaeffer  1 , Thomas Vaterrodt  2 , Laura Zaunbrecher  3 , Inga Liepelt-Scarfone  3   4   5 , Kirsten Emmert  6 , Benjamin Roeben  3   4 , Morad Elshehabi  6 , Clint Hansen  6 , Sara Becker  3 , Susanne Nussbaum  3 , Jan-Hinrich Busch  3 , Matthis Synofzik  3   4 , Daniela Berg  6   3 , Walter Maetzler  6   3
Affiliations

Effects of Levodopa on quality of sleep and nocturnal movements in Parkinson's Disease

Eva Schaeffer et al. J Neurol. 2021 Jul.

Abstract

Background: Sleep disturbances are common in Parkinson's Disease (PD), with nocturnal akinesia being one of the most burdensome. Levodopa is frequently used in clinical routine to improve nocturnal akinesia, although evidence is not well proven.

Methods: We assessed associations of Levodopa intake with quality of sleep and perception of nocturnal akinesia in three PD cohorts, using the Parkinson's Disease Sleep Scale (PDSS-2) in two cohorts and a question on nocturnal immobility in one cohort. In one cohort also objective assessment of mobility during sleep was performed, using mobile health technology.

Results: In an independent analysis of all three cohorts (in total n = 1124 PD patients), patients taking Levodopa CR reported a significantly higher burden by nocturnal akinesia than patients without Levodopa. Higher Levodopa intake and MDS-UPDRS part IV scores (indicating motor fluctuations) predicted worse PDSS-2 and higher subjective nocturnal immobility scores, while disease duration and severity were not predictive. Levodopa intake was not associated with objectively changed mobility during sleep.

Conclusion: Our results showed an association of higher Levodopa intake with perception of worse quality of sleep and nocturnal immobility in PD, indicating that Levodopa alone might not be suitable to improve subjective feeling of nocturnal akinesia in PD. In contrast, Levodopa intake was not relevantly associated with objectively measured mobility during sleep. PD patients with motor fluctuations may be particularly affected by subjective perception of nocturnal mobility. This study should motivate further pathophysiological and clinical investigations on the cause of perception of immobility during sleep in PD.

Keywords: Hypokinesia; Levodopa; Parkinson Disease; Sleep.

PubMed Disclaimer

Conflict of interest statement

E. Schaeffer received intramural research funding from the University of Kiel and speaker’s honoraria from Bayer Vital GmbH and Novartis, outside the submitted work. T. Vaterrodt, L. Zaunbrecher, K. Emmert, M. Elsehabi, B. Roeben, C. Hansen, S. Becker, S. Nussbaum and J-H. Busch have nothing to declare. I. Liepelt-Scarfone received an unrestricted research grant from Johnson & Johnson to conduct the ABC-PD study, and grants from the International Parkinson Fonds GmbH IPO, European Commission Horizon 2020, National Center of Excellence in Research, Luxembourg National Research Fund and Michael J Fox Foundation. M. Synofzik received Consultancy Honoraria von Actelion Pharmaceuticals, outside the submitted work. D. Berg reports grants from Janssen Pharmaceutica, grants from the Damp foundation, grants from the German Parkinson’s Disease Association (dPV), grants from BMWi, grants from BMBF, grants from the Parkinson Fonds Deutschland GmbH, grants and speaker’s honoraria from and consultancy honoraria of UCB Pharma GmbH, grants and speaker’s honoraria from TEVA Pharma GmbH, grants from and consultancies for Novartis Pharma GmbH, grants and speaker’s honoraria from and consultancy honoraria of Lundbeck, speaker’s honoraria from and consultancy honoraria for BIAL, speaker’s honoraria from and consultancy honoraria for Biogen, honoraria from Bayer and Zambon outside the submitted work. W. Maetzler receives or received funding from the European Union, the German Federal Ministry of Education of Research, Neuroalliance, Lundbeck and Janssen. He received speaker honoraria from Abbvie, Bayer, GlaxoSmithKline, Licher MT, Pharma, Takeda and UCB, was invited to Advisory Boards of Abbvie, Biogen, Lundbeck and Market Access & Pricing Strategy GmbH, and is an advisory board member of the Critical Path for Parkinson’s Consortium. He serves as the co-chair of the MDS Technology Task Force.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lees AJ, Blackburn NA, Campbell VL. The nighttime problems of Parkinson’s disease. Clin Neuropharmacol. 1988;11:512–519. doi: 10.1097/00002826-198812000-00004. - DOI - PubMed
    1. Bhidayasiri R, Sringean J, Taechalertpaisarn P, Thanawattano C. Capturing nighttime symptoms in Parkinson disease: Technical development and experimental verification of inertial sensors for nocturnal hypokinesia. J Rehabil Res Dev. 2016;53:487–498. doi: 10.1682/JRRD.2015.04.0062. - DOI - PubMed
    1. Pahwa R, Busenbark K, Huber SJ, et al. Clinical experience with controlled-release carbidopa/levodopa in Parkinson’s disease. Neurology. 1993;43:677–681. doi: 10.1212/wnl.43.4.677. - DOI - PubMed
    1. Pacchetti C, Martignoni E, Sibilla L, et al. Effectiveness of Madopar HBS plus Madopar standard in patients with fluctuating Parkinson’s disease: two years of follow-up. Eur Neurol. 1990;30:319–323. doi: 10.1159/000117364. - DOI - PubMed
    1. Jansen ENH, Meerwaldt JD. Madopar HBS in Parkinson patients with nocturnal akinesia. Clin Neurol Neurosurg. 1988;90:35–39. doi: 10.1016/S0303-8467(88)80007-6. - DOI - PubMed