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Effects of Continuous Dopaminergic Stimulation on Parkinson's Disease Gait: A Longitudinal Prospective Study with Levodopa Intestinal Gel Infusion.
- Source :
-
Journal of Parkinson's disease [J Parkinsons Dis] 2024; Vol. 14 (4), pp. 843-853. - Publication Year :
- 2024
-
Abstract
- Background: Gait issues, including reduced speed, stride length and freezing of gait (FoG), are disabling in advanced phases of Parkinson's disease (PD), and their treatment is challenging. Levodopa/carbidopa intestinal gel (LCIG) can improve these symptoms in PD patients with suboptimal control of motor fluctuations, but it is unclear if continuous dopaminergic stimulation can further improve gait issues, independently from reducing Off-time.<br />Objective: To analyze before (T0) and after 3 (T1) and 6 (T2) months of LCIG initiation: a) the objective improvement of gait and balance; b) the improvement of FoG severity; c) the improvement of motor complications and their correlation with changes in gait parameters and FoG severity.<br />Methods: This prospective, longitudinal 6-months study analyzed quantitative gait parameters using wearable inertial sensors, FoG with the New Freezing of Gait Questionnaire (NFoG-Q), and motor complications, as per the MDS-UPDRS part IV scores.<br />Results: Gait speed and stride length increased and duration of Timed up and Go and of sit-to-stand transition was significantly reduced comparing T0 with T2, but not between T0-T1. NFoG-Q score decreased significantly from 19.3±4.6 (T0) to 11.8±7.9 (T1) and 8.4±7.6 (T2) (T1-T0 p = 0.018; T2-T0 p < 0.001). Improvement of MDS-UPDRS-IV (T0-T2, p = 0.002, T0-T1 p = 0.024) was not correlated with improvement of gait parameters and NFoG-Q from T0 to T2. LEDD did not change significantly after LCIG initiation.<br />Conclusion: Continuous dopaminergic stimulation provided by LCIG infusion progressively ameliorates gait and alleviates FoG in PD patients over time, independently from improvement of motor fluctuations and without increase of daily dosage of dopaminergic therapy.
- Subjects :
- Humans
Male
Aged
Female
Middle Aged
Longitudinal Studies
Prospective Studies
Levodopa administration & dosage
Levodopa pharmacology
Parkinson Disease drug therapy
Parkinson Disease complications
Parkinson Disease physiopathology
Gait Disorders, Neurologic etiology
Gait Disorders, Neurologic drug therapy
Gait Disorders, Neurologic physiopathology
Gels
Carbidopa administration & dosage
Carbidopa pharmacology
Drug Combinations
Antiparkinson Agents administration & dosage
Antiparkinson Agents pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 1877-718X
- Volume :
- 14
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of Parkinson's disease
- Publication Type :
- Academic Journal
- Accession number :
- 38728203
- Full Text :
- https://doi.org/10.3233/JPD-240003