Objective: To evaluate the relationship between treatment with DA and the development of postural disorders (CC, PS and AC) in patients with PD.

Background: Stood posture, camptocormia (CC), Pisa syndrome (PS) and anterocollis (AC) are the most frequent postural disorders in PD and they generate disability, pain and reduce quality of life. Muscle weakness, dystonia,complications of surgical procedures and pharmacological treatments have been postulated as possible causes of such postural disorders. However the relationship between postural disorders and DA was not demonstrated to date.

Methods: We performed a case control study. Controls were PD patients without postural disorders. Medical charts were reviewed retrospectively. Information regarding gender, age, disease duration, medical history, cardiovascular risk factors, history of orthopedic disease, family history and PD features, was collected. Wilcoxon rank sum test and logistic regression models were used for comparisons between groups.

Results: 62 patients with PD and postural disorders (36 CC, 34 PS and 8 AC) and 101 controls were included. There were no differences in the treatment with levodopa between cases and controls (p=0.54). Regarding DA, 49 (78%) subjects that developed postural disorders had received this agents, while only 55 (54%) of controls were treated with these drugs (p=0.003). When analyzing drugs individually, while pramipexole (OR=1.51, p<0.001) and piribedil (OR=2.9, p=0.01) were associated with postural disorders, there was no significant effect for ropinirole (OR=0.9, p=0.06). Cases receiving concomitant treatment with amantadine showed higher risk of developing postural disorders (OR=2.2, p=0.01). Additionally, compared to controls, patient with postural disorders had older age (72.5±1.1 vs 67.3±1.0, p=0.001), higher H&Y (2.8±0.9 vs 1.9±0.8, p<0.001) and longer disease duration (8.1±7.8 vs 4.2±3.7, p<0.001). As well, cases when compared to controls had more falls (p=0.01), higher cognitive impairment (p<0.001), orthostatic hypotension (p<0.001), and urinary incontinence (p=0.02), in those patients that developed postural disorders.

Conclusions: Our results suggest a significant association between the use of DA and the development of postural disorders in PD, and potential risk factors including elderly, advanced disease, and concomitant treatment with amantadine. Prospective series will be crucial to confirm these associations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopamine-agonists-and-postural-disorders-in-parkinsons-disease/