Levodopa-induced dyskinesias in Parkinson's disease: is sensitization reversible?
Levodopa-induced dyskinesias (LIDs) in patients with Parkinson's disease are considered to result from the severity of dopaminergic denervation in the striatum, which is an irrevocable phenomenon, and sensitization induced by long-term intermittent administration of levodopa. Taking advantage of the 64% reduction of levodopa treatment allowed in 12 Parkinson's disease patients by continuous high-frequency stimulation of the subthalamic nucleus, we evaluated the severity of parkinsonian motor disability and LIDs during two levodopa challenges performed before the surgical implantation of the stimulation electrodes and after 8.8 months of continuous bilateral subthalamic nucleus stimulation that was interrupted 2 hours before the levodopa test. Motor disability during the "off" and "on" drug periods was unchanged. The severity of LIDs during the "on" period and dystonia during the "off" period decreased by 54% and 62%, respectively. The reduced severity of LIDs in the absence of subthalamic nucleus stimulation demonstrates that the sensitization phenomenon resulting from long-term intermittent levodopa administration is partially reversible.
Bejjani
B P
BP
Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289, Groupe-Hospitalier Pitié-Salpêtrière, Paris, France.
Arnulf
I
I
Demeret
S
S
Damier
P
P
Bonnet
A M
AM
Houeto
J L
JL
Agid
Y
Y
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D004185:Disability Evaluation; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000628:therapy; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology
D000978:Antiparkinson Agents; D007980:Levodopa