Objective: To determine the presence, severity, functional impact and predisposing factors of motor complications.

Background: Motor complications are well recognized in Parkinson’s disease (PD), but their reported prevalence varies and functional impact is less well studied. ​​​​​​

Method: Data were analyzed from 3 large prospective cohort studies of recent-onset PD patients followed for up to 12 years: Parkinson’s Progression Markers Initiative (PPMI), Tracking Parkinson’s and Oxford Discovery. Observations closest to the midpoint of successive 2-year time bands from the date of diagnosis were collated. Descriptive statistics were used to quantify the severity and functional impact of motor complications, using the Movement Disorder Society Unified PD rating scale part 4. Univariable and multivariable modeling were applied to assess associated factors.

Results: 3,343 cases were included in the analysis (64.7% male). 19.9% of patients were drug-naïve at 0-2 years, and 4.5% at 2-4 years. ‘Off’ periods affected 35.0% [95% CI 33.0, 37.0] at 4-6 years and 59.0% [55.6, 62.3] at 8-10 years, while dyskinesia affected 18.5% [95% CI 16.9, 20.2] at 4-6 years and 42.1% [38.7, 45.5] at 8-10 years. 13.4% [12.1, 14.9] had painful dystonia at 4-6 years, compared with 22.8% [20.1, 25.9] at 8-10 years. ‘Off’ time caused greater functional impact than dyskinesia, irrespective of disease duration. Dyskinesia and ‘off’ periods both increased with the levodopa equivalent daily dose (LEDD): at 8-10 years, 55.9% of patients in the highest LEDD quartile (mean LEDD 1,356 units) had dyskinesia, compared with 27.9% for those within the lowest LEDD quartile (mean LEDD 314 units). Similarly, at 8-10 years, 79.8% of patients within the highest LEDD quartile (mean LEDD 1,351) developed ‘off’ periods, compared with 41.9% of patients in the lowest LEDD quartile (mean LEDD 400). Women had higher rates of dyskinesia, dystonia and ‘off’ periods than men. Previously reported associations between motor complications and clinical variables were confirmed; additionally, there was a significant association between the development of motor complications and greater dopaminergic responsiveness, assessed by a challenge test.

Conclusion: ‘Off’ periods are significantly more common and consistently lead to greater functional impairment than dyskinesia during the first 12 years of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/motor-complications-in-parkinsons-disease/