Rate of progression of Parkinson's disease with early and delayed prescription of levodopa preparations.

Abstract

To optimize therapy with levodopa preparations in relation to the rate of disease progression. Eighty-six patients with Parkinson's disease (PD) were studied. Rate of progression was assessed by time of developing the 3rd stage of the disease. Patient state was assessed using MDS-UPDRS, MMSE, verbal activity test, clock drawing test, Beck depression scale, apathy scale and scale of autonomic disorders. In 37 patients, early prescription of levodopa preparations (on average 1,7 years after disease onset) facilitates a decrease in the rate of progression assessed by time of developing the 3rd stage of the disease (7,3±4,4 vs 5,8±2,8 years). Despite early levodopa prescription, dyskinesias developed in the same timeframe as in case of delayed prescription (7,5 vs 7,9 years since onset). Clinical features asymmetry as the disease progresses, behavior disorders in rapid eye movement sleep phase during premotor stage, and orthostatic hypotension can be predictors of the high risk of complications of levodopa therapy. More severe axial disturbances are an adverse predictor of more severe course of the disease, the low levodopa efficacy, and the low risk of dyskinesia. Therefore, delayed prescription of levodopa facilitates the rate of progression, wherein the development of medicinal dyskinesias depends, to a greater extent, on the duration of disease rather than on time of treatment onset.