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Abstract Details

Why Levodopa May Increase Falls in Parkinson's Disease
Movement Disorders
P06 - (-)
091
BACKGROUND: Levodopa usually improves the main symptoms of PD such as rigidity and bradykinesia. But there are conflicting reports of its effectiveness on balance and gait.
DESIGN/METHODS: 20 patients (mean age: 63.9 years, range 42-77 years; mean PD duration: 8.5 years, range 4-20 years) with balance difficulty were examined using the motor part of the revised UPDRS, tandem gait, and balance subtests such as turning 360o and standing on one foot. Patients were timed walking 7.63 meters (25 feet) and their steps were counted. The examination was conducted while off levodopa for at least 16 hours and repeated one hour after their standard dose of levodopa. Dyskinesias were assessed before and after levodopa. The t-test was used for comparing continuous variables and a chi-square test was used for comparing categorical variables.
RESULTS: UPDRS "off" score of 28.9 + 12.4 significantly decreased to an "on" score of 16.6 + 9.2. UPDRS subtests of gait and freezing of gait decreased (improved) significantly. Step length and velocity increased (improved) significantly. Dyskinesias increased on levodopa but were judged not to affect gait or balance. Subtests of balance including postural stability, turning, standing on one foot, and tandem gait decreased (improved) significantly. Improvements in gait on levodopa were greater than improvements in balance. This may be why some patients with balance difficulty fall more frequently: as gait speeds-up, because of levodopa, and as balance doesn't improve proportionately, patients fall.
CONCLUSIONS: Gait improved more than balance on levodopa. This may explain why in some patients levodopa may increase falls.
Authors/Disclosures
Rohit Dhall, MD, FAAN (University of Arkansas for Medical Sciences)
PRESENTER 		Dr. Dhall has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Best Doctors Inc. Dr. Dhall has stock in Verve Therapeutics Inc. Dr. Dhall has stock in Roche Holding Limited. Dr. Dhall has stock in Enliven Therapeutics Inc. The institution of Dr. Dhall has received research support from Amneal. The institution of Dr. Dhall has received research support from Neuroderm. The institution of Dr. Dhall has received research support from Cerevel Therapeutics. The institution of Dr. Dhall has received research support from Neurocrine. The institution of Dr. Dhall has received research support from Neuraly. The institution of Dr. Dhall has received research support from SPARC. The institution of Dr. Dhall has received research support from Pharma2B. The institution of Dr. Dhall has received research support from Alexion. The institution of Dr. Dhall has received research support from Parkinsons Foundation. The institution of Dr. Dhall has received research support from UCB Pharma. The institution of Dr. Dhall has received research support from Inhibikase Therapeutics. The institution of Dr. Dhall has received research support from Amylyx Pharma.
Jeffrey A. Cohen, MD (Cleveland Clinic) Dr. Cohen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Convelo. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PSI. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celltrion.
Narayanan Krishnamurthi No disclosure on file
Abraham N. Lieberman, MD, FAAN No disclosure on file
Sara S. Dhanani, MD (Banner Sun Health Research Institute) Dr. Dhanani has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie.
No disclosure on file