Treatment responsiveness of motor features in Parkinson’s disease

a matched case-control analysis

Angus MacLeod* (Corresponding Author), Carl Counsell

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Treatment response in PD is important clinically and for research diagnostic criteria but few objective data show treatment-responsiveness of PD motor features. Objectives: To evaluate the treatment response of motor features to moderate treatment doses in a “real-world” PD cohort. Methods: We analysed data from a community-based incident cohort of PD in North-East Scotland (PINE study). We assessed change in the UPDRS motor scale and its individual items over a period of up to 13 months comparing (i) patients with an increase of at least 300mg of levodopa-equivalent dose (LED) and (ii) patients without treatment change, matched for age, gender, and disease duration. Results: We identified 101 matched pairs of patients with and without a treatment increase. LED increases were mostly 300-375mg/day. 42% with treatment increase had ≥30% improvement in overall UPDRS motor score, a further 35% had substantial subjective improvement, but only one had an objective excellent (>70%) treatment response. Women responded better than men by 5.4 points (95% CI 2.7–8.1). All motor features improved with treatment, but after adjustment for age, gender, and initial score only rest tremor (p<0.001), rigidity (p=0.01), bradykinesia (<0.001), posture (p=0.01), gait (p=0.03) had significant improvements, compared to those with no treatment change. Dopa-less-responsive motor items, taken together, had small statistically significant relative improvements (1.1-point difference [95% CI 0.4–1.8], p=0.004). Conclusions: Motor items sometimes previously considered dopa-unresponsive have small improvements with moderate LED increases. Women respond better than men. Excellent treatment responses are uncommon. These data can inform clinical decisions about treatment.
Original languageEnglish
JournalMovement Disorders Clinical Practice
Publication statusAccepted/In press - 4 Oct 2019

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Parkinson Disease
Levodopa
Therapeutics
Dihydroxyphenylalanine
Hypokinesia
Scotland
Tremor
Posture
Gait

Keywords

  • Parkinson's disease
  • treatment response
  • motor features
  • levodopa

Cite this

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title = "Treatment responsiveness of motor features in Parkinson’s disease: a matched case-control analysis",
abstract = "Background: Treatment response in PD is important clinically and for research diagnostic criteria but few objective data show treatment-responsiveness of PD motor features. Objectives: To evaluate the treatment response of motor features to moderate treatment doses in a “real-world” PD cohort. Methods: We analysed data from a community-based incident cohort of PD in North-East Scotland (PINE study). We assessed change in the UPDRS motor scale and its individual items over a period of up to 13 months comparing (i) patients with an increase of at least 300mg of levodopa-equivalent dose (LED) and (ii) patients without treatment change, matched for age, gender, and disease duration. Results: We identified 101 matched pairs of patients with and without a treatment increase. LED increases were mostly 300-375mg/day. 42{\%} with treatment increase had ≥30{\%} improvement in overall UPDRS motor score, a further 35{\%} had substantial subjective improvement, but only one had an objective excellent (>70{\%}) treatment response. Women responded better than men by 5.4 points (95{\%} CI 2.7–8.1). All motor features improved with treatment, but after adjustment for age, gender, and initial score only rest tremor (p<0.001), rigidity (p=0.01), bradykinesia (<0.001), posture (p=0.01), gait (p=0.03) had significant improvements, compared to those with no treatment change. Dopa-less-responsive motor items, taken together, had small statistically significant relative improvements (1.1-point difference [95{\%} CI 0.4–1.8], p=0.004). Conclusions: Motor items sometimes previously considered dopa-unresponsive have small improvements with moderate LED increases. Women respond better than men. Excellent treatment responses are uncommon. These data can inform clinical decisions about treatment.",
keywords = "Parkinson's disease, treatment response, motor features, levodopa",
author = "Angus MacLeod and Carl Counsell",
note = "Dr Macleod was funded by a Clinical Academic Fellowship from the Scottish Chief Scientist Office (CAF 12/05) and a Clinical Lecturer Fellowship from the Scottish Chief Scientist Office and NHS Education for Scotland (PCL/17/10). He also received research funding from Parkinson’s UK (G-1302), the Academy of Medical Sciences and NHS Grampian Endowments relating to this research. Dr Counsell received research funding from Parkinson’s UK, Scottish Chief Scientist Office, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments, and SPRING relating to this research. We declare that we have no conflicts of interest. Funding sources for study: This study was supported by Parkinson’s UK, the Scottish Chief Scientist Office, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments, and SPRING.",
year = "2019",
month = "10",
day = "4",
language = "English",
journal = "Movement Disorders Clinical Practice",
issn = "2330-1619",
publisher = "Wiley",

}

TY - JOUR

T1 - Treatment responsiveness of motor features in Parkinson’s disease

T2 - a matched case-control analysis

AU - MacLeod, Angus

AU - Counsell, Carl

N1 - Dr Macleod was funded by a Clinical Academic Fellowship from the Scottish Chief Scientist Office (CAF 12/05) and a Clinical Lecturer Fellowship from the Scottish Chief Scientist Office and NHS Education for Scotland (PCL/17/10). He also received research funding from Parkinson’s UK (G-1302), the Academy of Medical Sciences and NHS Grampian Endowments relating to this research. Dr Counsell received research funding from Parkinson’s UK, Scottish Chief Scientist Office, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments, and SPRING relating to this research. We declare that we have no conflicts of interest. Funding sources for study: This study was supported by Parkinson’s UK, the Scottish Chief Scientist Office, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments, and SPRING.

PY - 2019/10/4

Y1 - 2019/10/4

N2 - Background: Treatment response in PD is important clinically and for research diagnostic criteria but few objective data show treatment-responsiveness of PD motor features. Objectives: To evaluate the treatment response of motor features to moderate treatment doses in a “real-world” PD cohort. Methods: We analysed data from a community-based incident cohort of PD in North-East Scotland (PINE study). We assessed change in the UPDRS motor scale and its individual items over a period of up to 13 months comparing (i) patients with an increase of at least 300mg of levodopa-equivalent dose (LED) and (ii) patients without treatment change, matched for age, gender, and disease duration. Results: We identified 101 matched pairs of patients with and without a treatment increase. LED increases were mostly 300-375mg/day. 42% with treatment increase had ≥30% improvement in overall UPDRS motor score, a further 35% had substantial subjective improvement, but only one had an objective excellent (>70%) treatment response. Women responded better than men by 5.4 points (95% CI 2.7–8.1). All motor features improved with treatment, but after adjustment for age, gender, and initial score only rest tremor (p<0.001), rigidity (p=0.01), bradykinesia (<0.001), posture (p=0.01), gait (p=0.03) had significant improvements, compared to those with no treatment change. Dopa-less-responsive motor items, taken together, had small statistically significant relative improvements (1.1-point difference [95% CI 0.4–1.8], p=0.004). Conclusions: Motor items sometimes previously considered dopa-unresponsive have small improvements with moderate LED increases. Women respond better than men. Excellent treatment responses are uncommon. These data can inform clinical decisions about treatment.

AB - Background: Treatment response in PD is important clinically and for research diagnostic criteria but few objective data show treatment-responsiveness of PD motor features. Objectives: To evaluate the treatment response of motor features to moderate treatment doses in a “real-world” PD cohort. Methods: We analysed data from a community-based incident cohort of PD in North-East Scotland (PINE study). We assessed change in the UPDRS motor scale and its individual items over a period of up to 13 months comparing (i) patients with an increase of at least 300mg of levodopa-equivalent dose (LED) and (ii) patients without treatment change, matched for age, gender, and disease duration. Results: We identified 101 matched pairs of patients with and without a treatment increase. LED increases were mostly 300-375mg/day. 42% with treatment increase had ≥30% improvement in overall UPDRS motor score, a further 35% had substantial subjective improvement, but only one had an objective excellent (>70%) treatment response. Women responded better than men by 5.4 points (95% CI 2.7–8.1). All motor features improved with treatment, but after adjustment for age, gender, and initial score only rest tremor (p<0.001), rigidity (p=0.01), bradykinesia (<0.001), posture (p=0.01), gait (p=0.03) had significant improvements, compared to those with no treatment change. Dopa-less-responsive motor items, taken together, had small statistically significant relative improvements (1.1-point difference [95% CI 0.4–1.8], p=0.004). Conclusions: Motor items sometimes previously considered dopa-unresponsive have small improvements with moderate LED increases. Women respond better than men. Excellent treatment responses are uncommon. These data can inform clinical decisions about treatment.

KW - Parkinson's disease

KW - treatment response

KW - motor features

KW - levodopa

M3 - Article

JO - Movement Disorders Clinical Practice

JF - Movement Disorders Clinical Practice

SN - 2330-1619

ER -