title: Motor fluctuations and dyskinesias in advanced/end stage Parkinson's disease: a study from a population of brain donors.
abstract: Treatment-related motor fluctuations (MFs) and dyskinesias are considered one of the most important problems in the long-term management of Parkinson's disease (PD). However, only a few studies have focused on their characteristics during advanced and end stages of the disease. We therefore assessed MFs and dyskinesias in a cohort of 61 late/end stage patients with a clinical and pathological diagnosis of PD and investigated the influence of disease- and treatment-related variables on their occurrence. A total of 62.3% of our patients experienced "wearing-off" phenomena, 68.9% "on-off" motor fluctuations and 60.7% dyskinesias at advanced/end stage disease. Age at disease onset and disease duration were significantly associated with dyskinesias. A substantial number of patients experienced spontaneous resolution of their motor complications during the last two years of their disease without treatment modifications. The clinical heterogeneity of treatment-related motor complications in PD points towards a complex mechanism for their etiopathogenesis. Although advanced disease and L-dopa administration are closely tied to their development, other mechanisms involving synaptic aging, altered neuronal plasticity and post-synaptic degeneration may be involved.
authors.affiliation: Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA. spapapetropoulos@med.miami.edu
authors.forename: S
authors.initials: S
authors.lastname: Papapetropoulos
authors.forename: D C
authors.initials: DC
authors.lastname: Mash
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000978:Antiparkinson Agents / Q000009:adverse effects; D001921:Brain / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology*; D015331:Cohort Studies; D018450:Disease Progression; D004409:Dyskinesia, Drug-Induced / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D009410:Nerve Degeneration / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000187:drug effects / Q000502:physiology; D010300:Parkinson Disease / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D009435:Synaptic Transmission / Q000187:drug effects / Q000502:physiology; D014019:Tissue Donors
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa