Disability in Activities of Daily Living and Severity of Dyskinesias Determine the Handicap of Parkinson's Disease Patients in Advanced Stage Selected to DBS.
There is scarce data on the level of handicap in Parkinson's disease (PD) and none in advanced stage PD.



To assess the handicap in advanced stage PD patients with disabling levodopa-induced motor complications selected to deep brain stimulation (DBS).



Data was prospectively recorded during routine evaluation for DBS. Handicap was measured using London Handicap Scale (LHS) (0 = maximal handicap; 1 = no handicap). Disease severity was evaluated using the Hoehn & Yahr scale and the UPDRS/MDS-UPDRS, during off and on after a supra-maximal dose of levodopa. Schwab and England Scale (S&E) was scored in off and on. Dyskinesias were scored using the modified Abnormal Involuntary Movement Scale (mAIMS). Results concern cross-sectional assessment before DBS.



100 PD patients (mean age 61 (±7.6); mean disease duration 12.20 (±4.6) years) were included. Median score of motor MDS-UPDRS was 54 in off and 25 in on. Mean total LHS score was 0.56 (±0.14). Patients were handicapped in several domains with a wide range of severity. Physical Independence and Social Integration were the most affected domains. Determinants of total LHS score were MDS-UPDRS part II off (β= -0.271; p = 0.020), S&E on (β= 0.264; p = 0.005) and off (β= 0.226; p = 0.020), and mAIMS on (β= -0.183; p = 0.042) scores (R2  = 29.6%).



We were able to use handicap to measure overall health condition in advanced stage PD. Patients were moderately to highly handicapped and this was strongly determined by disability in ADL and dyskinesias. Change in handicap may be a good patient-centred outcome to assess efficiency of DBS.
Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.|Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Miguel
M
Coelho
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Daisy
D
Abreu
Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.|Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Leonor
L
Correia-Guedes
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Patricia Pita
PP
Lobo
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Margherita
M
Fabbri
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Catarina
C
Godinho
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Josefa
J
Domingos
Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.|Language Research Laboratory, Instituto de Medicina Molecular, Lisbon, Portugal.
Luisa
L
Albuquerque
Language Research Laboratory, Instituto de Medicina Molecular, Lisbon, Portugal.
Vanda
V
Freitas
Department of Neurosciences, Service of Psychiatry and Mental Health, Hospital Santa Maria, Lisbon, Portugal.
João Miguel
JM
Pereira
Department of Neurosciences, Service of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal.
Begona
B
Cattoni
Department of Neurosciences, Service of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal.
Herculano
H
Carvalho
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.|Department of Neurosciences, Service of Neurological Imaging, Hospital Santa Maria, Lisbon, Portugal.
Sofia
S
Reimão
Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.|Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.|Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Mário M
MM
Rosa
Department of Neurosciences, Service of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal.
António Gonalves
AG
Ferreira
Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.|Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.|Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Joaquim J
JJ
Ferreira
D000203:Activities of Daily Living; D046690:Deep Brain Stimulation; D004185:Disability Evaluation; D004409:Dyskinesia, Drug-Induced / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index
D007980:Levodopa
London Handicap Scale; Parkinson’s disease; advanced stage; handicap; motor complications