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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
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Abstract:

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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

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