RSS-Feed abonnieren

DOI: 10.1590/0004-282X20180074
Motor and non-motor wearing-off and its impact in the quality of life of patients with Parkinson's disease
Flutuações motoras e não-motoras e seu impacto na qualidade de vida de pacientes com doença de Parkinson
ABSTRACT
The wearing-off phenomenon is common in patients with Parkinson's disease. Motor and non-motor symptoms can fluctuate in relation to the “on/off” periods.
Objective: To assess the impact of motor and non-motor wearing-off on activities of daily living and quality of life of patients with PD.
Methods: A cross-sectional study was carried out. All patients were evaluated using the Movement Disorders Society Unified Parkinson's Disease Rating Scale. Wearing-off was assessed using the Wearing-Off Questionnaire-19, and quality of life was assessed using the Parkinson's Disease Questionnaire-8.
Results: A total of 271 patients were included; 73.4% had wearing-off; 46.8% had both motor and non-motor fluctuations. Patients with both motor and non-motor wearing-off had a worst quality of life compared with those with only motor fluctuations (p = 0.047).
Conclusions: Motor and non-motor fluctuations have an impact on activities of daily living and quality of life. Non-motor wearing-off may have a higher impact.
RESUMO
O fençmeno de encurtamento do fim de dose é comum em pacientes com doença de Parkinson. Tanto os sintomas motores quanto os não motores podem flutuar em relação aos períodos de “on/off”.
Objetivo: Avaliar o impacto das flutuações motoras e não-motoras nas atividades da vida diária e qualidade de vida em pacientes com doença de Parkinson.
Métodos: Um estudo transversal foi realizado. Todos os sujeitos foram avaliados utilizando a escala unificada para a doença de Parkinson da Sociedade de Distúrbios do Movimento. O encurtamento do fim de dose foi avaliado através do questionário WOQ-19 e a qualidade de vida foi avaliada através do PDQ-8.
Resultados: Um total de 271 pacientes foram incluídos, 73,4% tiveram deterioração de fim de dose. A maioria dos pacientes tiveram tanto flutuações motoras quanto não-motoras (46,8%). Os pacientes com ambos os tipos de flutuações motoras e não-motoras tiveram pior qualidade de vida do que pacientes apenas com flutuações motoras (p = 0.047).
Conclusões: Pacientes com flutuações motoras e não-motoras tiveram impacto significativo nas atividades da vida diária e na qualidade de vida. As flutuações não-motoras parecem ter um impacto maior que as flutuações motoras sobre a qualidade de vida.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Publikationsverlauf
Eingereicht: 29. Januar 2018
Angenommen: 24. April 2018
Artikel online veröffentlicht:
23. August 2023
© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Fahn S, Oakes D, Shoulson I, Kieburtz K, Rudolph A, Lang A et al. Levodopa and the progression of Parkinson's disease. N Engl J Med. 2004 Dec;351(24):2498-508. https://doi.org/10.1056/NEJMoa033447
- 2 Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson disease: A randomized controlled trial. JAMA. 2000 Oct;284(15):1931-8. https://doi.org/10.1001/jama.284.15.1931
- 3 Storch A, Schneider CB, Wolz M, Stürwald Y, Nebe A, Odin P et al. Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications. Neurology. 2013 Feb;80(9):800-9. https://doi.org/10.1212/WNL.0b013e318285c0ed
- 4 Brun L, Lefaucheur R, Fetter D, Derrey S, Borden A, Wallon D et al. Non-motor fluctuations in Parkinson's disease: prevalence, characteristics and management in a large cohort of parkinsonian outpatients. Clin Neurol Neurosurg. 2014 Dec;127:93-6. https://doi.org/10.1016/j.clineuro.2014.10.006
- 5 Rizos A, Martinez-Martin P, Odin P, Antonini A, Kessel B, Kozul TK et al. Characterizing motor and non-motor aspects of early-morning off periods in Parkinson's disease: an international multicenter study. Parkinsonism Relat Disord. 2014 Nov;20(11):1231-5. https://doi.org/10.1016/j.parkreldis.2014.09.013
- 6 Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP et al. The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Mov Disord. 2009 Aug;24(11):1641-9. https://doi.org/10.1002/mds.22643
- 7 Gallagher DA, Lees AJ, Schrag A. What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them? Mov Disord. 2010 Nov;25(15):2493-500. https://doi.org/10.1002/mds.23394
- 8 Stocchi F. The levodopa wearing-off phenomenon in Parkinson's disease: pharmacokinetic considerations. Expert Opin Pharmacother. 2006 Jul;7(10):1399-407. https://doi.org/10.1517/14656566.7.10.1399
- 9 Stacy MA, Murck H, Kroenke K. Responsiveness of motor and nonmotor symptoms of Parkinson disease to dopaminergic therapy. Prog Neuropsychopharmacol Biol Psychiatry. 2010 Feb;34(1):57-61. https://doi.org/10.1016/j.pnpbp.2009.09.023
- 10 Witjas T, Kaphan E, Azulay JP, Blin O, Ceccaldi M, Pouget J et al. Nonmotor fluctuations in Parkinson's disease: frequent and disabling. Neurology. 2002 Aug;59(3):408-13. https://doi.org/10.1212/WNL.59.3.408
- 11 Antonini A, Martinez-Martin P, Chaudhuri RK, Merello M, Hauser R, Katzenschlager R et al. Wearing-off scales in Parkinson's disease: critique and recommendations. Mov Disord. 2011 Oct;26(12):2169-75. https://doi.org/10.1002/mds.23875
- 12 Stacy M, Hauser R. Development of a Patient Questionnaire to facilitate recognition of motor and non-motor wearing-off in Parkinson's disease. J Neural Transm (Vienna). 2007 Feb;114(2):211-7. https://doi.org/10.1007/s00702-006-0554-y
- 13 Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181-4. https://doi.org/10.1136/jnnp.55.3.181
- 14 Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord. 2010 Nov;25(15):2649-53. https://doi.org/10.1002/mds.23429
- 15 Martinez-Martin P, Rodriguez-Blazquez C, Alvarez-Sanchez M, Arakaki T, Bergareche-Yarza A, Chade A et al. Expanded and independent validation of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). J Neurol. 2013 Jan;260(1):228-36. https://doi.org/10.1007/s00415-012-6624-1
- 16 Seki M, Takahashi K, Uematsu D, Mihara B, Morita Y, Isozumi K et al. Clinical features and varieties of non-motor fluctuations in Parkinson's disease: a Japanese multicenter study. Parkinsonism Relat Disord. 2013 Jan;19(1):104-8. https://doi.org/10.1016/j.parkreldis.2012.08.004
- 17 Martinez-Martin P, Tolosa E, Hernandez B, Badia X; ValidQUICK Study Group. Validation of the “QUICK” questionnaire—a tool for diagnosis of “wearing-off” in patients with Parkinson's disease. Mov Disord. 2008 Apr;23(6):830-6. https://doi.org/10.1002/mds.21944
- 18 Stocchi F, Jenner P, Obeso JA. When do levodopa motor fluctuations first appear in Parkinson's disease? Eur Neurol. 2010;63(5):257-66. https://doi.org/10.1159/000300647
- 19 Richard IH, Frank S, McDermott MP, Wang H, Justus AW, LaDonna KA et al. The ups and downs of Parkinson disease: a prospective study of mood and anxiety fluctuations. Cogn Behav Neurol. 2004 Dec;17(4):201-7.
- 20 Hinnell C, Hurt CS, Landau S, Brown RG, Samuel M; PROMS-PD Study Group. Nonmotor versus motor symptoms: how much do they matter to health status in Parkinson's disease? Mov Disord. 2012 Feb;27(2):236-41. https://doi.org/10.1002/mds.23961
- 21 Qin Z, Zhang L, Sun F, Fang X, Meng C, Tanner C. Health related quality of life in early Parkinson's disease: impact of motor and non-motor symptoms, results from Chinese levodopa exposed cohort. Parkinsonism Relat Disord. 2009;15:767e71. https://doi.org/10.1016/j.parkreldis.2009.05.011