Abstract
Many patients with idiopathic Parkinson's disease treated with levodopa for more than five years develop fluctuations in their clinical response to this drug. Such fluctuations may be unpredictable, but more commonly occur in a regular pattern related to the size and timing of the levodopa dosage. Theories as to their cause have emphasised both the progression of the underlying Parkinson's disease and the possibility of a late side-effect of levodopa. We report two children with Parkinsonism, one after recurrent obstructive hydrocephalus and the other following an encephalitic illness. Both patients had striking improvement with levodopa, but developed predictable and unpredictable dramatic response fluctuations within weeks of starting levodopa therapy. This suggests that neither the pathology of idiopathic Parkinson's disease, nor the long-term use of levodopa are essential for the development of predictable or unpredictable fluctuations in response to levodopa therapy.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Carlier G., Dubru J. M. Familial juvenile Parkinsonism. Acta Paediatr Belg. 1979 Apr-Jun;32(2):123–127. [PubMed] [Google Scholar]
- Dougan D., Wade D., Mearrick P. Effects of L-dopa metabolites at a dopamine receptor suggest a basis for 'on-off' effect in Parkinson's disease. Nature. 1975 Mar 6;254(5495):70–72. doi: 10.1038/254070a0. [DOI] [PubMed] [Google Scholar]
- Düby S. E., Cotzias G. C., Papavasiliou P. S., Lawrence W. H. Injected apomorphine and orally administered levodopa in Parkinsonism. Arch Neurol. 1972 Dec;27(6):474–480. doi: 10.1001/archneur.1972.00490180010004. [DOI] [PubMed] [Google Scholar]
- Lee T., Seeman P., Rajput A., Farley I. J., Hornykiewicz O. Receptor basis for dopaminergic supersensitivity in Parkinson's disease. Nature. 1978 May 4;273(5657):59–61. doi: 10.1038/273059a0. [DOI] [PubMed] [Google Scholar]
- Lesser R. P., Fahn S., Snider S. R., Cote L. J., Isgreen W. P., Barrett R. E. Analysis of the clinical problems in parkinsonism and the complications of long-term levodopa therapy. Neurology. 1979 Sep;29(9 Pt 1):1253–1260. doi: 10.1212/wnl.29.9_part_1.1253. [DOI] [PubMed] [Google Scholar]
- Markham C. H., Diamond S. G. Evidence to support early levodopa therapy in Parkinson disease. Neurology. 1981 Feb;31(2):125–131. doi: 10.1212/wnl.31.2.125. [DOI] [PubMed] [Google Scholar]
- Papavasiliou P. S., McDowell F. H., Wang Y. Y., Rosal V., Miller S. T. Plasma DOPA and growth hormone in parkinsonism: oscillations in symptoms. Neurology. 1979 Feb;29(2):194–200. doi: 10.1212/wnl.29.2.194. [DOI] [PubMed] [Google Scholar]
- Shoulson I., Glaubiger G. A., Chase T. N. On-off response. Clinical and biochemical correlations during oral and intravenous levodopa administration in parkinsonian patients. Neurology. 1975 Dec;25(12):1144–1148. doi: 10.1212/wnl.25.12.1144. [DOI] [PubMed] [Google Scholar]
- Yamamura Y., Sobue I., Ando K., Iida M., Yanagi T. Paralysis agitans of early onset with marked diurnal fluctuation of symptoms. Neurology. 1973 Mar;23(3):239–244. doi: 10.1212/wnl.23.3.239. [DOI] [PubMed] [Google Scholar]