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Objective: To compare acute and chronic effects of l-dopa on bladder function in levodopa-naive Parkinson disease (PD) patients who had urinary urgency., Methods: We evaluated 26 l-dopa-naive PD patients at a university-based PD center with a first urodynamic session with a double examination: in the off treatment condition and 1 hour after acute challenge with carbidopa/l-dopa 50/200 mg; then, a chronic l-dopa monotherapy was administered (mean dose 300 +/- 150 mg). Two months later, patients underwent a second urodynamic session with a single evaluation 1 hour after the acute carbidopa/l-dopa challenge., Results: The first acute l-dopa challenge significantly worsened bladder overactivity (neurogenic overactive detrusor contractions threshold [NDOC-t; 32% of worsening] and bladder capacity [BC; 22% of worsening]); on the contrary, l-dopa challenge during chronic administration ameliorated the first sensation of bladder filling (FS; 120% of improvement), NDOCT-t (93% improvement), and BC (33% of improvement) vs the values obtained with acute administration. An 86% significant improvement of FS in comparison with the basal value was observed., Conclusions: The acute and chronic l-dopa effects may be due to the different synaptic concentrations or to the activation of postsynaptic mechanisms obtained by chronic administration.

The present study aims to provide neurophysiological evidence of ipsilateral activation during motor recovery in patients after stroke. The effects of cortical reorganization were investigated using magnetic brain stimulation in order to record motor evoked potentials (MEPs) both from contralateral and ipsilateral hands. Ten healthy subjects and 13 patients were examined. The patients had suffered their first hemispheric stroke and consequent motor deficit. While ipsilateral responses (iMEPs) were absent in normal subjects, they were obtained from both ipsilateral and contralateral hands in patients. The ipsilateral MEP differed from contralateral MEP in the following respects: (1) elicitation during contraction; (2) a shorter latency; (3) a lower amplitude. The presence of optimal iMEPs (lower excitability threshold, larger amplitude) in recovered hands points to a role for the undamaged hemisphere, and in particular to the involvement of secondary motor areas. We suggest that iMEPs in general may be a marker of brain plasticity, and that the specific type described here appear in the context of fast autochthonous motor recovery.