Acute vs chronic effects of l-dopa on bladder function in patients with mild Parkinson disease.
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.
Brusa
L
L
Clinica Neurologica, Università Tor Vergata Roma, Roma, Italy.
Petta
F
F
Pisani
A
A
Moschella
V
V
Iani
C
C
Stanzione
P
P
Miano
R
R
Finazzi-Agrò
E
E
D000208:Acute Disease / Q000628:therapy; D002230:Carbidopa / Q000008:administration & dosage / Q000009:adverse effects; D002908:Chronic Disease / Q000628:therapy; D015259:Dopamine Agents / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000187:drug effects / Q000503:physiopathology; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017777:Parasympathetic Fibers, Postganglionic / Q000187:drug effects / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D009435:Synaptic Transmission / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000139:chemically induced* / Q000188:drug therapy* / Q000503:physiopathology; D014555:Urination Disorders / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology
D015259:Dopamine Agents; D007980:Levodopa; D002230:Carbidopa