Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-06T04:25:35.819Z Has data issue: false hasContentIssue false
  • English
  • Français

Gait Analysis in Advanced Parkinson's Disease – Effect of Levodopa and Tolcapone

Published online by Cambridge University Press:  02 March 2017

Din-E Shan ,
Shwn-Jen Lee ,
Ling-Yi Chao  and
Shyh-Ing Yeh
Din-E Shan*
Affiliation:
Neurological Institute, Taipei Veterans General Hospital, Department of Neurology, National Yang-Ming University, Taipei, Taiwan, Republic of China
Shwn-Jen Lee
Affiliation:
Department of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, Republic of China
Ling-Yi Chao
Affiliation:
Department of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, Republic of China
Shyh-Ing Yeh
Affiliation:
Neurological Institute, Taipei Veterans General Hospital, Department of Neurology, National Yang-Ming University, Taipei, Taiwan, Republic of China
*
Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, 11217, Republic of China
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To determine the therapeutic effect of levodopa/benserazide and tolcapone on gait in patients with advanced Parkinson's disease.

Methods:

Instrumental gait analysis was performed in 38 out of 40 patients with wearing-off phenomenon during a randomized, double-blind, placebo-controlled trial of tolcapone.

Results:

Gait analysis disclosed a significant improvement by levodopa/benserazide in walking speed, stride length and the range of motion of hip, knee and ankle joints. At the end of the study, both the UPDRS motor scores during off-period and the percentage of off time improved significantly using tolcapone. However, gait analysis could not confirm this improvement. With respect to levodopa/benserazide effect, the reduction in rigidity correlated with improved angular excursion of the ankle, whereas the decreased bradykinesia correlated with improved stride length and angular excursion of the hip and knee joints.

Conclusion:

The results of our gait analysis confirmed that in parkinsonian patients with fluctuating motor symptoms levodopa/benserazide, but not tolcapone, produced a substantial improvement.

Résumé:

RÉSUMÉ:Objectif:

Le but de cette étude était de déterminer l'effet thérapeutique de la lévodopa/bensérazide et du tolcapone sur la démarche, chez les patients en phase avancée de la maladie de Parkinson.

Méthodes:

Une analyse instrumentale de la démarche a été réalisée chez 38 de 40 patients ayant un phénomène de détérioration de fin de dose pendant un essai randomisé, en double insu, contrôlé par placebo, du tolcapone.

Résultats:

L'analyse de la démarche a montré une amélioration significative pendant le traitement par la lévodopa/bensérazide de la vitesse de la marche, de la longueur des foulées et de l'amplitude des mouvements des articulations de la hanche, du genou et de la cheville. À la fin de l'étude, les scores moteurs UPDRS pendant la période "off et le pourcentage de temps "off ont été améliorés significativement par le tolcapone. Cependant, l'analyse de la démarche n'a pas pu confirmer cette amélioration. En ce qui concerne l'effet de la préparation lévodopa/bensérazide, la diminution de la rigidité était corrélée avec l'amélioration de l'excursion angulaire de la cheville, alors que la diminution de la bradykinésie était corrélée à une amélioration de la longueur des foulées et à l'excursion angulaire des articulations de la hanche et du genou.

Conclusion:

Les résultats de notre analyse de la démarche confirment que, chez les parkinsoniens qui ont des symptômes moteurs fluctuants, la lévodopa/bensérazide procure une amélioration importante, ce qui n'est pas observé avec le tolcapone.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 1 , February 2001 , pp. 70 - 55
Copyright
Copyright © The Canadian Journal of Neurological 2001

References

REFERENCES

1. Blin, O, Ferrandez, AM, Pailhous, J, Serratrice, G. Dopa-sensitive and dopa-resistant gait parameters in Parkinson’s disease. J Neurol Sci 1991; 103: 51–54.CrossRefGoogle ScholarPubMed
2. Morris, ME, Iansek, R, Matyas, TA, Summers, JJ. The pathogenesis of gait hypokinesia in Parkinson’s disease. Brain 1994; 117: 1169–1181.Google Scholar
3. Weller, C, O’Neill, CJ, Charlett, A, et al. Defining small differences in efficacy between antiparkinsonian agents using gait analysis: a comparison of two controlled release formulations of levodopa/decarboxylase inhibitor. Br J Clin Pharmacol 1993; 35: 379–385.CrossRefGoogle ScholarPubMed
4. Pedersen, SW, Eriksson, T, Oberg, B. Effects of withdrawal of antiparkinson medication on gait and clinical score in the Parkinson patient. Acta Neurol Scand 1991; 84: 7–13.Google Scholar
5. Bowes, SG, Clark, PK, Leeman, AL, et al. Determinants of gait in the elderly parkinsonian on maintenance levodopa/carbidopa therapy. Br J Clin Pharmacol 1990; 30: 13–24.Google Scholar
6. Morris, ME, Matyas, TA, Iansek, R, Summers, JJ. Temporal stability of gait in Parkinson’s disease. Phys Ther 1996; 76: 763–777.Google Scholar
7. O’Sullivan, JD, Said, CM, Dillon, LC, Hoffman, M, Hughes, AJ. Gait analysis in patients with Parkinson’s disease and motor fluctuations – influence of levodopa and comparison with other measures of motor function. Mov Disord 1998; 13: 900–906.CrossRefGoogle ScholarPubMed
8. Marsden, CD. Parkinson’s disease. J Neurol Neurosurg Psychiatry 1994; 57: 672–681.CrossRefGoogle ScholarPubMed
9. Kopin, IJ. The pharmacology of Parkinson’s disease therapy: an update. Annu Rev Pharmacol Toxicol 1993; 33: 467–495.CrossRefGoogle ScholarPubMed
10. Cedarbaum, J. Clinical pharmacokinetics of antiparkinsonian drugs. Clin Pharmacokinet 1987; 13: 141–178.Google Scholar
11. Davis, TL, Roznoski, M, Burns, RS. Acute effects of COMT inhibition on L-DOPA pharmacokinetics in patients treated with carbidopa and selegiline. Clin Neuropharmacol 1995; 18: 333–337.Google Scholar
12. Dingemanse, J, Jorga, K, Zurcher, G, et al. Pharmacokinetic-pharmacodynamic interaction between the COMT inhibitor tolcapone and single-dose levodopa. Br J Clin Pharmacol 1995; 40: 253–262.Google Scholar
13. Roberts, JW, Cora-Locatelli, G, Bravi, D, et al. Catechol-O-methyltransferase inhibitor tolcapone prolongs levodopa/carbidopa action in parkinsonian patients. Neurology 1993; 43: 2685–2688.Google Scholar
14. Kurth, MC, Adler, CH, Hilaire, MS, et al. Tolcapone improves motor function and reduces levodopa requirement in patients with Parkinson’s disease experiencing motor fluctuations: a multicenter, double-blind, randomized, placebo-controlled trial. Neurology 1997; 48: 81–87.CrossRefGoogle ScholarPubMed
15. Rajput, AH, Martin, W, Saint-Hilaire, MH, Dorflinger, E, Pedder, S. Tolcapone improves motor function in parkinsonian patients with the “wearing-off phenomenon: a double-blind, placebo-controlled, multicenter trial. Neurology 1997; 49: 1066–1071.CrossRefGoogle ScholarPubMed
16. Baas, H, Beiske, AG, Ghika, J, et al. Catechol-O-methyltransferase inhibition with tolcapone reduces the “wearing off phenomenon and levodopa requirements in fluctuating parkinsonian patients. J Neurol Neurosurg Psychiatry 1997; 63: 421–428.CrossRefGoogle ScholarPubMed
17. Adler, CH, Singer, C, O’Brien, C, et al. Randomized, placebo-controlled study of tolcapone in patients with fluctuating Parkinson disease treated with levodopa-carbidopa. Arch Neurol 1998; 55: 1089–1095.Google Scholar
18. Hughes, AJ, Ben-Shlomo, Y, Daniel, SE, Lees, AJ. What features improve the accuracy of clinical diagnosis in Parkinson’s disease: a clinicopathologic study. Neurology 1992; 42: 1142–1146.Google Scholar
19. Lang, AE, Fahn, S. Assessment of Parkinson’s disease. Munsant, TL, ed. Quantification of Neurological Deficit. Woburn, MA: Butterworths, 1989; 285–309.Google Scholar
20. Oxford Metrics, L. Vicon Clinical Manager User’s Manual. England: Oxford Metrics, Ltd. 1995.Google Scholar
21. Davis, RB, Ounpuu, S, Tyburski, D, Gage, JR. A gait analysis data collection and reduction technique. Human Movement Science 1991; 10: 575–582.Google Scholar
22. Kaakkola, S, Gordin, A, Mannisto, PT. General properties and clinical possibilities of new selective inhibitors of catechol-O-methyltransferase. Gen Pharmacol 1994; 25: 813–824.CrossRefGoogle ScholarPubMed
23. Rivest, J, Barclay, CL, Suchowersky, O. COMT inhibitors in Parkinson’s disease. Can J Neurol Sci 1999; 26 Suppl 2: S34–38.CrossRefGoogle ScholarPubMed
24. Limousin, P, Pollak, P, Pfefen, JP, et al. Acute administration of levodopa-benserazide and tolcapone, a COMT inhibitor, Parkinson’s disease. Clin Neuropharmacol 1995; 18: 258–265.Google Scholar
25. Davis, TL, Roznoski, M, Burns, RS. Effects of tolcapone in Parkinson’s patients taking L-dihydroxyphenylalanine/carbidopa and selegiline. Mov Disord 1995; 10: 349–351.Google Scholar
26. Tohgi, H, Abe, T, Yamazaki, K, et al. Effects of the catechol-O-methyltransferase inhibitor tolcapone in Parkinson’s disease: correlations between concentrations of dopaminergic substances in the plasma and cerebrospinal fluid and clinical improvement. Neurosci Lett 1995; 192: 165–168.Google Scholar