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Risk thresholds of levodopa dose for dyskinesia in Chinese patients with Parkinson’s disease: a pilot study

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Abstract

Levodopa is widely used to treat Parkinson’s disease (PD), and its long-term therapy may induce dyskinesia in a dose-dependent manner. However, the threshold dose with a relatively low risk for dyskinesia has not been determined. Demographic, clinical profiles and detailed information of dopaminergic drugs were recorded for 403 PD patients in treatment with levodopa. Variables were compared between dyskinesia and non-dyskinesia groups. Logistic regression analysis was used to assess the association between levodopa dose–related variables and dyskinesia. Receiver operating characteristic curve and decision tree classification model were used to investigate the cut-off value of levodopa dose to best separate the dyskinesia group from the non-dyskinesia group. Patients with dyskinesia tended to have a lower weight and age at onset, higher percentage of female and wearing-off, longer duration of disease and levodopa treatment, higher H-Y stage and MDS-UPDRS Part III score, and higher levodopa dose and levodopa equivalent dose than those without dyskinesia. After adjusted for demographical and clinical variables, levodopa dose–related factors (daily dose, cumulative dose, and weight-adjusted dose) were still associated with dyskinesia. Both the receiver operating characteristic and decision tree classification analysis indicated that patients who have taken levodopa dose ≤ 400 mg per day may be associated with a reduced risk for dyskinesia. In conclusion, we evaluated the thresholds of levodopa treatment with a relatively low risk for dyskinesia. These data should be considered for prevention and management of dyskinesia in patients with PD.

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Acknowledgments

This research was supported by the National Key R&D Program of China (no. 2016YFC1306501), the National Natural Science Foundation of China (no. 81571226, no. 81771367, and no. 31600724), Beijing Municipal Science and Technology Commission (no. z17110700100000, no. Z171100000117013). Beijing Nature Science Foundation (no. 7174297), and Beijing outstanding talents cultivation (no. 2016000021469G210).

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Authors and Affiliations

  1. Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Nansihuan, Beijing, 100070, China

    Genliang Liu, Dongning Su, Dongxu Wang, Meimei Zhang, Xuemei Wang, Zhan Wang, Yaqin Yang, Ying Jiang, Huizi Ma & Tao Feng

  2. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Genliang Liu, Huimin Chen, Dongning Su, Dongxu Wang, Meimei Zhang, Xuemei Wang, Zhan Wang, Yaqin Yang, Ying Jiang, Huizi Ma & Tao Feng

  3. Parkinson’s Disease Center, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

    Tao Feng

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  1. Genliang Liu
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All authors have participated in the research and article preparation.

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Correspondence to Tao Feng.

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This study was approved by the Ethics Committee of the Beijing Tiantan Hospital and was performed in accordance with the Declaration of Helsinki. Informed consent was obtained either from the participants or their closest relatives.

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Liu, G., Chen, H., Su, D. et al. Risk thresholds of levodopa dose for dyskinesia in Chinese patients with Parkinson’s disease: a pilot study. Neurol Sci 41, 111–118 (2020). https://doi.org/10.1007/s10072-019-04043-7

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  • DOI: https://doi.org/10.1007/s10072-019-04043-7

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