Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990

Jay A Van Gerpen, Neeraj Kumar, James Howard Bower, Stephen Weigand, J. Eric Ahlskog

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Background: The threat of levodopa-induced dyskinesias often influences early treatment decisions in those with Parkinson disease. Objective: To determine the long-term risks of levodopa-associated dyskinesias of any severity, dyskinesias sufficient to require medication adjustment, and dyskinesias failing medication adjustments. Design: The medical records linkage system of the Rochester Epidemiology Project was used to identify all incident Parkinson disease patients treated with levodopa (1976-1990). All records were independently reviewed by 2 neurologists who recorded demographic and drug data, dates when dyskinesias were initially identified, and dates when dyskinesias were sufficient to require medication changes; dyskinesias not controlled by drug adjustments were also tabulated. Results: We identified 126 incident Parkinson disease patients treated with levodopa for at least 2 months. By Kaplan-Meier analysis, the estimated rate of dyskinesias was 30% by 5 treatment years and 59% by 10 years. However, the rate of dyskinesias requiring medication adjustment was estimated to be only 17% by 5 years and 43% by 10 years. At 10 treatment years, the rate of dyskinesias that could not be controlled with medication adjustments was estimated at only 12%. An increased risk was associated with younger age and higher initial levodopa dose, but not with sex. Conclusions: Levodopa-associated dyskinesias can be expected to develop in nearly 60% of patients in our community after 10 years, but these will be severe enough to require medication adjustments in only 43% of patients. At 10 treatment years, nearly 90% of these patients can expect to be spared dyskinesias that could not be controlled by drug adjustments. This populationbased study suggests dyskinesia risk may not be a major concern for most Parkinson disease patients.

Original languageEnglish (US)
Pages (from-to)205-209
Number of pages5
JournalArchives of Neurology
Volume63
Issue number2
DOIs
StatePublished - Feb 2006

Fingerprint

Dyskinesias
Levodopa
Parkinson Disease
Parkinson's Disease
Medical Record Linkage
Medication
Pharmaceutical Preparations
Kaplan-Meier Estimate
Therapeutics
Epidemiology
Controlled
Drugs
Demography

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990. / Van Gerpen, Jay A; Kumar, Neeraj; Bower, James Howard; Weigand, Stephen; Ahlskog, J. Eric.

In: Archives of Neurology, Vol. 63, No. 2, 02.2006, p. 205-209.

Research output: Contribution to journalArticle

Van Gerpen, Jay A ; Kumar, Neeraj ; Bower, James Howard ; Weigand, Stephen ; Ahlskog, J. Eric. / Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990. In: Archives of Neurology. 2006 ; Vol. 63, No. 2. pp. 205-209.
@article{e34d7bcdc8af4ec59f050513873a1699,
title = "Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990",
abstract = "Background: The threat of levodopa-induced dyskinesias often influences early treatment decisions in those with Parkinson disease. Objective: To determine the long-term risks of levodopa-associated dyskinesias of any severity, dyskinesias sufficient to require medication adjustment, and dyskinesias failing medication adjustments. Design: The medical records linkage system of the Rochester Epidemiology Project was used to identify all incident Parkinson disease patients treated with levodopa (1976-1990). All records were independently reviewed by 2 neurologists who recorded demographic and drug data, dates when dyskinesias were initially identified, and dates when dyskinesias were sufficient to require medication changes; dyskinesias not controlled by drug adjustments were also tabulated. Results: We identified 126 incident Parkinson disease patients treated with levodopa for at least 2 months. By Kaplan-Meier analysis, the estimated rate of dyskinesias was 30{\%} by 5 treatment years and 59{\%} by 10 years. However, the rate of dyskinesias requiring medication adjustment was estimated to be only 17{\%} by 5 years and 43{\%} by 10 years. At 10 treatment years, the rate of dyskinesias that could not be controlled with medication adjustments was estimated at only 12{\%}. An increased risk was associated with younger age and higher initial levodopa dose, but not with sex. Conclusions: Levodopa-associated dyskinesias can be expected to develop in nearly 60{\%} of patients in our community after 10 years, but these will be severe enough to require medication adjustments in only 43{\%} of patients. At 10 treatment years, nearly 90{\%} of these patients can expect to be spared dyskinesias that could not be controlled by drug adjustments. This populationbased study suggests dyskinesia risk may not be a major concern for most Parkinson disease patients.",
author = "{Van Gerpen}, {Jay A} and Neeraj Kumar and Bower, {James Howard} and Stephen Weigand and Ahlskog, {J. Eric}",
year = "2006",
month = "2",
doi = "10.1001/archneur.63.2.205",
language = "English (US)",
volume = "63",
pages = "205--209",
journal = "Archives of Neurology",
issn = "0003-9942",
publisher = "American Medical Association",
number = "2",

}

TY - JOUR

T1 - Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990

AU - Van Gerpen, Jay A

AU - Kumar, Neeraj

AU - Bower, James Howard

AU - Weigand, Stephen

AU - Ahlskog, J. Eric

PY - 2006/2

Y1 - 2006/2

N2 - Background: The threat of levodopa-induced dyskinesias often influences early treatment decisions in those with Parkinson disease. Objective: To determine the long-term risks of levodopa-associated dyskinesias of any severity, dyskinesias sufficient to require medication adjustment, and dyskinesias failing medication adjustments. Design: The medical records linkage system of the Rochester Epidemiology Project was used to identify all incident Parkinson disease patients treated with levodopa (1976-1990). All records were independently reviewed by 2 neurologists who recorded demographic and drug data, dates when dyskinesias were initially identified, and dates when dyskinesias were sufficient to require medication changes; dyskinesias not controlled by drug adjustments were also tabulated. Results: We identified 126 incident Parkinson disease patients treated with levodopa for at least 2 months. By Kaplan-Meier analysis, the estimated rate of dyskinesias was 30% by 5 treatment years and 59% by 10 years. However, the rate of dyskinesias requiring medication adjustment was estimated to be only 17% by 5 years and 43% by 10 years. At 10 treatment years, the rate of dyskinesias that could not be controlled with medication adjustments was estimated at only 12%. An increased risk was associated with younger age and higher initial levodopa dose, but not with sex. Conclusions: Levodopa-associated dyskinesias can be expected to develop in nearly 60% of patients in our community after 10 years, but these will be severe enough to require medication adjustments in only 43% of patients. At 10 treatment years, nearly 90% of these patients can expect to be spared dyskinesias that could not be controlled by drug adjustments. This populationbased study suggests dyskinesia risk may not be a major concern for most Parkinson disease patients.

AB - Background: The threat of levodopa-induced dyskinesias often influences early treatment decisions in those with Parkinson disease. Objective: To determine the long-term risks of levodopa-associated dyskinesias of any severity, dyskinesias sufficient to require medication adjustment, and dyskinesias failing medication adjustments. Design: The medical records linkage system of the Rochester Epidemiology Project was used to identify all incident Parkinson disease patients treated with levodopa (1976-1990). All records were independently reviewed by 2 neurologists who recorded demographic and drug data, dates when dyskinesias were initially identified, and dates when dyskinesias were sufficient to require medication changes; dyskinesias not controlled by drug adjustments were also tabulated. Results: We identified 126 incident Parkinson disease patients treated with levodopa for at least 2 months. By Kaplan-Meier analysis, the estimated rate of dyskinesias was 30% by 5 treatment years and 59% by 10 years. However, the rate of dyskinesias requiring medication adjustment was estimated to be only 17% by 5 years and 43% by 10 years. At 10 treatment years, the rate of dyskinesias that could not be controlled with medication adjustments was estimated at only 12%. An increased risk was associated with younger age and higher initial levodopa dose, but not with sex. Conclusions: Levodopa-associated dyskinesias can be expected to develop in nearly 60% of patients in our community after 10 years, but these will be severe enough to require medication adjustments in only 43% of patients. At 10 treatment years, nearly 90% of these patients can expect to be spared dyskinesias that could not be controlled by drug adjustments. This populationbased study suggests dyskinesia risk may not be a major concern for most Parkinson disease patients.

UR - http://www.scopus.com/inward/record.url?scp=32944466421&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=32944466421&partnerID=8YFLogxK

U2 - 10.1001/archneur.63.2.205

DO - 10.1001/archneur.63.2.205

M3 - Article

C2 - 16476808

AN - SCOPUS:32944466421

VL - 63

SP - 205

EP - 209

JO - Archives of Neurology

JF - Archives of Neurology

SN - 0003-9942

IS - 2

ER -