Abstract Details

Title Levodopa-induced dyskinesia in Atypical Parkinsonism: A population-based cohort study

Topic Movement Disorders

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-011

Objective Investigate levodopa-induced dyskinesia in a population-based cohort of atypical parkinsonism.

Background Few studies have examined levodopa-induced dyskinesia in atypical parkinsonism.

Design/Methods

In our 1991-2010 population-based parkinsonism-incident cohort of Olmsted County, MN, we identified all patients with atypical parkinsonisms and abstracted information about levodopa-induced dyskinesia. We subsequently compared atypical parkinsonism patients to Parkinson disease (PD) patients from the same population-based cohort.

Results Data about levodopa use and dyskinesia was available for 337/344 atypical parkinsonism patients (98.0%). Among these, 150 (44.5%) were treated with levodopa; 11.3% of levodopa-treated patients developed dyskinesia. Among dyskinetic patients, median age at diagnosis was 73.5 years (range: 54-80), 58.8% were male, the median follow-up time from levodopa initiation to dyskinesia onset was 3 years (range: 2-5), and the median levodopa dose was 600 mg (range: 300-900). Dyskinesia severity led to levodopa adjustments or amantadine initiation in eight patients, with improvement in seven. Patients with dyskinesia were diagnosed with parkinsonism at a significantly younger age compared to patients without dyskinesia (p=0.03) with no other differences between groups. In models adjusted for age, sex, and levodopa dose, patients with atypical parkinsonism have lower odds of developing dyskinesia compared to PD patients (OR=0.31, 95% CI 0.17, 0.57; p<0.001). However, in analysis combing atypical parkinsonism and PD patients, higher dose of levodopa was associated with higher odds of dyskinesia, independent of age, sex, and diagnosis (OR=3.39, 95% CI 1.82, 6.32, p<0.001). Five dyskinetic patients underwent autopsy and the pathological diagnosis was consistent with the clinical diagnosis.

Conclusions

Levodopa-induced dyskinesia affected only 11.3% of patients with atypical parkinsonism. Atypical parkinsonisms are associated with lower odds of developing levodopa-induced dyskinesia compared to PD, independent of levodopa dose.

Authors/Disclosures
Pierpaolo Turcano, MD (Rush University Medical Center) PRESENTER	Dr. Turcano has nothing to disclose.
Cole D. Stang	Mr. Stang has nothing to disclose.
James H. Bower, MD, MSc, FAAN (Mayo Clinic)	The institution of Dr. Bower has received research support from Abbvie.
	No disclosure on file
J. E. Ahlskog, MD, PhD (Mayo Clinic)	Dr. Ahlskog has received publishing royalties from a publication relating to health care.
Michelle M. Mielke, PhD (Wake Forest University School of Medicine)	Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LabCorp. Dr. Mielke has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Siemens Healthineers. Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sunbird Bio. Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Mielke has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. Dr. Mielke has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novo Nordisk.
Rodolfo Savica, MD, PhD, FAAN (Mayo Clinic)	The institution of Dr. Savica has received research support from ACADIA Pharmaceuticals, Inc.

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