Objective: This study is for the clinical effect of levodopa in parkinsonism.

Background: Levodopa was common used in Parkinson disease. Levodopa induced dyskinesia(LID) is the major concern in clinical practice. However, many patients had transient parkinsonism with 2 core symptoms of Parkinson disease. It is difficult to differentiating in the beginning. Therapeutic diagnosis with levodopa was necessary in such a condition. In the clinical practice, some patients with parkinsonism had good response to levodopa and long-term benefit without dyskinesia. Levodopa could modify the patient’s basal ganglion function and regain the motor ability.

Methods: Retrospect analysis was done for the patients who received levodopa treatment by one neurologist in a medical center in middle Taiwan, from January to December, 2016.

Results: There are 112 patients reviewed in this study. Ten patients (9%) were treated with levodopa for involuntary movement and gait difficulty; 7 patients (6%) had dementia picture more than parkinsonism without LID. In the parkinsonism group, 8 patients (7.1%) with troublesome dyskinesia and one was even under 300mg levodopa equivalent daily dose (a 41-year-old female with Parkinson disease). Nine patients (8%) were “benign course” for long term good effect for low dose levodopa (<600mg for more than 4 years).

Conclusions: Levodopa induced dyskinesia might relate to dopaminergic receptor dysregulation and GABAnergic dysfunction, especially in young onset Parkinson disease. In aged patients or transient/mild basal ganglion dysfunction patients, LID seldom developed. In this study, 7.1% patients treated with levodopa induced troublesome dyskinesia and most in the young onset and advanced Parkinson disease. In the clinical practice, LID would influence physicians to prescribe levodopa, which might delay the treatment. Slow titration of levodopa and patient selection could lower the risk for the troublesome complication.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-practice-of-levodopa-in-parkinsonism/