Actigraph analysis of diurnal motor fluctuations during dopamine agonist therapy.
BACKGROUND
Generally, clinicians use rating scales or descriptive writing to characterize diurnal changes in motor signs and symptoms in Parkinson's disease (PD); however, these ratings are subjective and are not easily reproducible.


OBJECTIVE
To examine the usefulness of actigraphy as an objective indicator of akinesia by long-term, continuous measurement of limb motor activity (MA), visualize 24-hour circadian profiles of akinesia, and quantitatively detect cabergoline (CBG) efficacy in both hospitalized patients and outpatients with Parkinson's disease.


METHODS
MA was continuously recorded with a wrist-worn activity monitor (actigraph) in 29 hospitalized PD patients without tremor or abnormal involuntary movements. In another series consisting of 8 outpatients, the response duration of CBG was measured by using averaged actigraphy.


RESULTS
By averaging data gathered every 24 h over several days, it was possible to quantify the circadian patterns of akinesia. These cumulative evaluations of the patients' motor status determined 4 types of akinesia: (1) a wearing-off pattern seen in advanced efficacy stages, (2) stable response, (3) afternoon akinesia, and (4) morning akinesia. Following CBG therapy, the MA increased significantly throughout the daytime, i.e.: by 40% in the morning (8:00 a.m. to 12:00 noon), by 60% in the afternoon (12:00 noon to 6:00 p.m.), and by 60% in the next early morning (from time to get up until 8:00 a.m.).


CONCLUSIONS
In averaged motor activity, the charting of cumulative evaluations of motor status revealed the long-acting efficacy of CBG in ameliorating existing motor fluctuations throughout the daytime and even promoting sleep benefit in the next morning. Averaged actigraphy is considered to be useful in the quantitative detection of drug responses to parkinsonian akinesia and its circadian variations. This enables titration of the lowest dose of drugs needed to alleviate akinesia.
Katayama
S
S
Southern Tohoku Research Institute for Neuroscience, Kohriyama, Fukushima, Japan. skatayama@dream.com
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D000077465:Cabergoline; D002940:Circadian Rhythm; D004594:Electrophysiology; D004873:Ergolines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009043:Motor Activity; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology*
D000978:Antiparkinson Agents; D004873:Ergolines; D000077465:Cabergoline