PECULIARITIES OF MOTOR FLUCTUATIONS AT DIFFERENT FORMS OF PARKINSON'S DISEASE

Abstract

Levodopa is known as one of the most effective drugs for the treatment of Parkinson's disease. Unfortunately, there is no levodopa, which does not have side effects on the body under the long-term use. After several years of receiving this therapy, the response to this medicine changes in most patients: the duration of the single dose action decreases, sharp fluctuations in the patient's condition (motor fluctuations) and dyskinesia appear. The purpose of our study is to investigate the frequency and nature of motor fluctuations in various forms of Parkinson's disease and to evaluate their impact on the quality of life of patients. We examined 80 patients with Parkinson's disease who were undergoing inpatient treatment at the neurological department of the Sklifosovsky Poltava Regional Clinical Hospital and the Center for patients with Parkinson's disease and other neurodegenerative diseases at the Department of Nervous Diseases, Poltava State Medical University. Age, length of the disease, length of levodopa therapy and levodopa dosage, frequency and nature of motor fluctuations were evaluated. The diagnosis was established according to the criteria of the World Brain Bank of Great Britain. The degree of clinical manifestations was assessed according to the unified rating scale for the assessment of Parkinson's disease modified by the International Society of Parkinson's Disease and Movement Disorders and the Hoehn and Yahr scale. The assessment of daily activity was carried out according to the scale of Schwab and England.
 To assess motor fluctuations and dyskinesia, we used the patients’ diary filled out on their own for 3 days before the visit to the clinic. According to the diary, the duration of the "off period" was determined over the treatment course. Depending on the form of the disease, the following groups were distinguished: group I including 40 patients with akinetic-rigid form; group II involved 40 patients with a mixed akinetic-rigid-tremor form. It has been found out that the onset of both forms of Parkinson's disease occurs mainly in old age, which is characterized by metabolic changes that may play a role in susceptibility to the therapy with levodopa drugs. These groups of patients demonstrated no statistically significant differences by the age, the age of the diseases onset, the duration of the disease and the duration of therapy with levodopa drugs, and the stage according to the Hen and Yar scale. According to the scale of Schwab and England, a higher level of dependence on assistance was revealed in group I compared to group II that may be caused by more pronounced motor disorders and motor fluctuations.
 The study has demonstrated that patients with various forms of Parkinson's disease show differences in the severity of movement disorders, in particular, in the quality of motor complications of levodopa therapy, manifested in the form of motor fluctuations, provided that clinical severity, duration of the disease and the use of levodopa drugs are matched. At the same time, different forms of Parkinson's disease do not differ in the prevalence of different types of motor fluctuations and require the development of new approaches to the correction of these conditions.