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H A N D I N I R A H M I D E W I

Journal Reading


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Autonomic symptoms and dopaminergictreatment in de novo Parkinson’s disease


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Introduction

Autonomic symptoms are common features in Parkinson’sdisease (PD) with considerale impact on !uality of life andthey are present already in very early PD

"istopathological studies indicate that theneurodegeneration underlying PD involves oth central andperipheral autonomic structures

#n the other hand$ autonomic dysfunction is fre!uently

descried as a potential side effect of dopaminergictreatment


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Patients and methods

I n d i v i d u a l s w i t h p r e v i o u s l y n o t d i a g n o s e d P D $ f u l f i l l i n g

a c k n o w l e d g e d c l i n i c a l d i a g n o s t i c c r i t e r i a w h e n a s s e s s e d o t h c l o s e t o d i a g n o s i s ( a s e l i n e ) a n d a f t e r a m e a n

f o l l o w % u p t i m e o f & ' m o n t h s w e r e i n c l u d e d ( n & & )

* r o m t h e t o t a l i n i t i a l a s e l i n e p o p u l a t i o n $ w e e + c l u d e d , p a t i e n t s e c a u s e o f d e a t h ( n & ) $ r e - e c t e d p a r t i c i p a t i o n ( n . ) $ u s e

o f d o p a m i n e r g i c m e d i c a t i o n e f o r e i n c l u s i o n ( n / ) $ i n c o m p l e t e d a t a ( n . ) a n d e + c l u s i v e t r e a t m e n t w i t h 0 A # % 1 i n h i i t o r s ( 0 A # % 1 i ) a f t e r y e a r ( n 2 ) $ l e a v i n g 3 p a t i e n t s e l i g i l e f o r t h i s s t u d y 4


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5+amination

Autonomic symptoms were assessed y interview at aseline and after & months using a preliminary version of the 0ovement Disorder 6ocietysponsored

new version of the 7nified Parkinson’s DiseaseRating 6cale


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0edication

8he 9evodopa%e!uivalent daily dose(95D) at &%month follow%up was

calculated as follows: 95D milligram(mg) standard levodopa ; mg

sustained release levodopa 2/43. ; mglevodopa taken together with

entacapone 2/4&. ; mg ropinirole2


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Result

After & months follow%up$ ,/ of 3 patients ('&@) receiveddopaminergic treatment (D8)$ either levodopa only (9D$ n


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7rinary dysfunction and constipation tended to e more fre!uent and dysphagia less fre!uentin treated patients at &%month follow%upcompared with aseline

the regression models showed that higher 95Dcorrelated with reduction in dysphagia severityscore


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Discussion

#ur results complement the evidencethat dopaminergic medication hasonly a minor impact on autonomic

symptoms in early PD and that theseverity of these symptoms remainslow after initiation of symptomatic

treatment4

Although dysphagia is often laelled asnon%responsive to dopaminergic

treatment$ partial improvement has een reported following othlevodopa$ apomorphine and

stimulation of the suthalamic nucleus


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e conclude that dopaminergic treatment has arather minor impact on autonomic symptoms inpatients with early and previously untreated PD4 Itmay improve dysphagia ut lead to increasedconstipation and orthostatic di??iness4

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