Levodopa-Induced Dyskinesias are Frequent and Impact Quality of Life in Parkinson's Disease: A 5-Year Follow-Up Study

Abstract

Background: Levodopa-induced dyskinesias (LID) are frequent in Parkinson's disease (PD).

Objective: To analyze the change in the frequency of LID over time, identify LID related factors, and characterize how LID impact on patients' quality of life (QoL).

Patients and methods: PD patients from the 5-year follow-up COPPADIS cohort were included. LID were defined as a non-zero score in the item "Time spent with dyskinesia" of the Unified Parkinson's Disease Rating Scale-part IV (UPDRS-IV). The UPDRS-IV was applied at baseline (V0) and annually for 5 years. The 39-item Parkinson's disease Questionnaire Summary Index (PQ-39SI) was used to asses QoL.

Results: The frequency of LID at V0 in 672 PD patients (62.4 ± 8.9 years old; 60.1% males) with a mean disease duration of 5.5 ± 4.3 years was 18.9% (127/672) and increased progressively to 42.6% (185/434) at 5-year follow-up (V5). The frequency of disabling LID, painful LID, and morning dystonia increased from 6.9%, 3.3%, and 10.6% at V0 to 17.3%, 5.5%, and 24% at V5, respectively. Significant independent factors associated with LID (P < 0.05) were a longer disease duration and time under levodopa treatment, a higher dose of levodopa, a lower weight and dose of dopamine agonist, pain severity and the presence of motor fluctuations. LID at V0 (β = 0.073; P = 0.027; R² = 0.62) and to develop disabling LID at V5 (β = 0.088; P = 0.009; R² = 0.73) were independently associated with a higher score on the PDQ-39SI.

Conclusion: LID are frequent in PD patients. A higher dose of levodopa and lower weight were factors associated to LID. LID significantly impact QoL.

Keywords: Parkinson's disease; dyskinesia; morning akinesia; motor fluctuations; quality of life.

Figure 1

(A) Frequency of LID, disabling LID, painful LID and early morning dystonia at baseline (V0; N = 672) and annually for 5 years: V1 (12 months ± 1 month; N = 604); V2 (24 months ± 1 month; N = 517); V3 (36 months ± 2 months; N = 482); V4 (48 months ±3 months; N = 465); V5 (60 months ± 3 months; N = 434). (B) Frequency of awake time with LID according to the UPDRS‐IV‐item 32 at V0, V1, V2, V3, V4 and V5. (C) Degree of severity of LID according to the UPDRS‐IV‐Item 33 at V0, V1, V2, V3, V4 and V5. (D) Frequency of LID, disabling LID, painful LID and early morning dystonia at V0 regarding the time under levodopa therapy in the group of patients receiving levodopa at V0 (N = 490). P value < 0.0001 for all analysis except for early morning dystonia (P = 0.032). LID, levodopa‐induced dyskinesias; UPDRS, Unified Parkinson's Disease Rating Scale.

Figure 2

Mean and standard deviation at V0, V2, V4 and V5 in the PDQ‐39SI (A), PQ‐10 (B) and EUROHIS‐QOL8 (C) in patients with LID versus without LID at each visit. *P < 0.05 for comparison at each visit between both groups. EUROHIS‐QOL8, EUROHIS‐QOL 8‐item index; PDQ‐39, the 39‐item Parkinson's disease Questionnaire Summary Index.