title: Clinical phenotype and risk of levodopa-induced dyskinesia in Parkinson's disease.
abstract: It is unclear whether patients with different clinical phenotypes of Parkinson's disease (PD) differ in their risk of developing levodopa-induced dyskinesia. We evaluated the possible association between clinical phenotypes and risk of levodopa-induced dyskinesia in PD patients using a case-control design. The FRAGAMP study is a large Italian multicenter study. Patients affected by PD diagnosed according to the Gelb's criteria were enrolled and underwent a face-to-face interview. Clinical scales were used to evaluate motor and cognitive impairment. Presence of dyskinesia was assessed by the item 32 of the UPDRS section IV. On the basis of the most prominent motor symptoms at onset PD, patients were classified as tremor-dominant, akinetic-rigid, or mixed type. 485 PD patients (292 men; mean age 65.6 ± 9.8) were enrolled in the study of whom 128 (26.4 %) presented levodopa-induced dyskinesia. Of the 485 patients, 311 (64.1 %) were classified as tremor-dominant, 104 (21.4 %) as Akinetic-Rigid and 70 (14.4 %) as mixed type. Multivariate logistic regression analysis showed a significant negative association between tremor-dominant phenotype and levodopa-induced dyskinesia (adjusted OR 0.48; 95 % CI 0.23-1.00; p value 0.05). When analysis was stratified by age at onset a stronger negative association was found among the late onset (>50 years) PD patients (OR 0.28; 95 % CI 0.11-0.70; p value 0.007) while no association was found among patients with an early onset. Our findings support the hypothesis that the occurrence of resting tremor as an initial manifestation of PD may predict a lower probability of developing levodopa-induced dyskinesia.
authors.affiliation: Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nicoletti
authors.affiliation: Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mostile
authors.affiliation: Istituto di Bioimmagini e Fisiologia Molecolare, Consiglio Nazionale delle Ricerche, Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nicoletti
authors.affiliation: Clinica Neurologica, Università "Magna Græcia" di Catanzaro, Catanzaro, Italy.
authors.forename: Gennarina
authors.initials: G
authors.lastname: Arabia
authors.affiliation: Dipartimento di Scienze mediche di base, neuroscienze e organi di senso, Università di Bari, Bari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Iliceto
authors.affiliation: Dipartimento di Scienze mediche di base, neuroscienze e organi di senso, Università di Bari, Bari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Lamberti
authors.affiliation: Divisione di Neurologia, Ospedale Misericordia, Grosseto, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marconi
authors.affiliation: Dipartimento di Neuroscienze, Università di Messina, Messina, Italy.
authors.forename: Letterio
authors.initials: L
authors.lastname: Morgante
authors.affiliation: Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Salerno, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Barone
authors.affiliation: Istituto di Bioimmagini e Fisiologia Molecolare, Consiglio Nazionale delle Ricerche, Catanzaro, Italy.|Clinica Neurologica, Università "Magna Græcia" di Catanzaro, Catanzaro, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Quattrone
authors.affiliation: Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. m.zappia@unict.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Zappia
mesh_terms: D000367:Age Factors; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D004409:Dyskinesia, Drug-Induced / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007558:Italy / Q000453:epidemiology; D007980:Levodopa / Q000009:adverse effects* / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010300:Parkinson Disease / Q000188:drug therapy* / Q000453:epidemiology*; D010641:Phenotype; D012306:Risk; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Akinetic-rigid; Clinical phenotype; Dyskinesia; Parkinson’s disease; Tremor-dominant