title: Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test.
abstract: Non-motor symptoms (NMS) are extremely common among late-stage Parkinson's disease (LSPD) patients. Levodopa (L-dopa) responsiveness seems to decrease with disease progression but its effect on NMS in LSPD still needs to be investigated.
  
  
  
  To assess the response of blood pressure (BP), pain, fatigue and anxiety to L-dopa in LSPD patients.
  
  
  
  20 LSPD patients, defined as Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 (MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (advanced PD group) underwent an L-dopa challenge. BP and orthostatic hypotension (OH) assessment, a visual analogue scale (VAS) for pain and fatigue and the Strait Trait Anxiety (STAI) were evaluated before and after the L-dopa challenge.
  
  
  
  Systolic BP dropped significantly after L-dopa intake (p < 0.05) in LSPD patients, while there was no change in pain, fatigue or anxiety. L-dopa significantly improved (p < 0.05) pain and anxiety in the advanced PD group, whereas it had no effect on BP or fatigue. L-dopa-related adverse effects (AEs), namely OH and sleepiness, were more common among LSPD patients. 40% and 65% of LSPD patients were not able to fill out the VAS and the STAI, respectively, while measurement of orthostatic BP was not possible in four LSPD patients.
  
  
  
  This exploratory study concludes that some non-motor variables in LSPD do not benefit from the acute action of L-dopa while it can still induce disabling AEs. There is a need for assessment tools of NMS adapted to these disabled LSPD patients.
authors.affiliation: Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Margherita
authors.initials: M
authors.lastname: Fabbri
authors.affiliation: Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Coelho
authors.affiliation: Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: Leonor Correia
authors.initials: LC
authors.lastname: Guedes
authors.affiliation: Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: Ines
authors.initials: I
authors.lastname: Chendo
authors.affiliation: Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Sousa
authors.affiliation: Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Rosa
authors.affiliation: Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Daisy
authors.initials: D
authors.lastname: Abreu
authors.affiliation: Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Nilza
authors.initials: N
authors.lastname: Costa
authors.affiliation: Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal; Center for Interdisciplinary Research Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Godinho
authors.affiliation: Fondazione Ospedale San Camillo-I.R.C.C.S., Parkinson and Movement Disorders Unit, Venice, Italy; Department of Neurosciences (DNS), Padova University, Padova, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.affiliation: Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Department of Neurosciences, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal. Electronic address: joaquimjferreira@gmail.com.
authors.forename: Joaquim J
authors.initials: JJ
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy* / Q000209:etiology; D001794:Blood Pressure / Q000187:drug effects; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D064232:Visual Analog Scale
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Late-stage; Levodopa; Non-motor symptoms; Parkinson's disease