Polyneuropathy in levodopa-treated Parkinson's patients

Szadejko, Karol; Dziewiatowski, Krzysztof; Szabat, Krzysztof; Robowski, Piotr; Schinwelski, Michał; Sitek, Emilia J.; Sławek, Jarosław

doi:10.1016/j.jns.2016.09.061

Cited by 18 publications

(32 citation statements)

References 54 publications

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“…The association between PNP and oral l ‐dopa was evaluated in 19 studies, , including a total of 1,137 patients. A total of 353 PNPs were described, with a large predominance of slowly progressive axonal neuropathy selectively involving the sensory fibers.…”

Section: Resultsmentioning

confidence: 99%

“…The association between PNP and l ‐dopa dosage was evaluated in 16 studies: 12 found an association between PNP and higher doses of l ‐dopa, whereas four showed negative results . Three studies did not provide any measures of association between PNP and l ‐dopa dosage …”

Section: Resultsmentioning

confidence: 99%

“…The association between PNP and duration of l ‐dopa therapy was evaluated in eight studies, with positive results in 4 cases . Ceravolo and colleagues described a 3.08‐fold increased risk of PNP in patients with long (more than 3 years) versus short (less than 3 years) exposure to l ‐dopa.…”

Section: Resultsmentioning

confidence: 99%

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Levodopa‐Induced Neuropathy: A Systematic Review

Romagnolo

Merola

Artusi

et al. 2018

Movement Disord Clin Pract

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Background Background: Clinical, neurophysiological, and pathological evidence suggest an association between Parkinson's disease (PD) and peripheral neuropathy (PNP), with a possible causative role of levodopa metabolic products, such as homocysteine and methylmalonic acid. Methods Methods: We conducted a systematic review of studies reporting cases of PNP in L-dopa-treated PD patients indexed in PubMed between January 1990 and March 2018. ResultsResults: We identified 38 articles reporting cases of PNP in PD patients treated with oral L-dopa or with L-dopa/ carbidopa intestinal gel infusion (LCIG). Prevalence of PNP was 30.2% in the former group and 42.1% in the latter. Oral L-dopa was mostly associated with slowly progressive PNP, whereas LCIG showed an acute or subacute onset in 35.7% of cases. In both groups, there was an association between PNP and higher L-dopa doses, as well as with the following biochemical alterations: increased homocysteine; reduced vitamin B12; increased methylmalonic acid; and reduced vitamin B6. A skin biopsy was performed in 181 patients, showing signs of small fibers neuropathy in 169 (93.4%). Positive, yet preliminary, results were observed in patients receiving periodic vitamin supplementation. Conclusions Conclusions: Over one third of PD patients in treatment with L-dopa may develop PNP, with a significantly higher prevalence of acute and subacute forms in those receiving LCIG. Pathogenic mechanisms remain unclear, but possibly related to a complex interplay between peripheral neurodegenerative processes and L-dopa neurotoxic metabolites. Prospective, randomized, clinical trials are required to identify factors associated with the onset and progression of PD-associated PNP and clarify the protective role of B-group vitamin supplementation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Levodopa‐Induced Neuropathy: A Systematic Review

Romagnolo

Merola

Artusi

et al. 2018

Movement Disord Clin Pract

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confidence: 99%

“…New data have found a higher prevalence of polyneuropathy in PD patients than in age-matched controls (4)(5)(6)(7). Peripheral nerve fiber impairment in PD can take the form of large fiber neuropathy (PN) in L-Dopa treated patients (5)(6)(7)(8)(9)(10)(11)(12) or small fiber neuropathy (SFN) in all PD patients (13)(14)(15). A se-ries of data consider PN to be secondary to L-Dopa intake that determines the accumulation of homocysteine and methylmalonic acid, and cyanocobalamin, pyridoxine or folate plasma deficits (4,(6)(7)(8)11,(16)(17)(18).…”

mentioning

confidence: 99%

The impact of associated large-fiber peripheral neuropathy on health-related quality of life in Parkinson’s disease – results from a Romanian cohort

Vanta¹,

Pintea²,

Perju‐Dumbravă³

2019

Ro J Neurol.

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background. Recent studies described a higher prevalence of peripheral neuropathy (PN) in Parkinson's disease that was linked to L-Dopa exposure. Peripheral neuropathies are known causes of a decreased health-related quality of life (HrQoL). Until now, no studies addressed the issue of how or if associated PN in PD affects HrQoL. Methods. In a cross-sectional, observational study, 73 non-demented PD patients, from which 36 with confirmed PN based on clinical (using the Toronto Clinical Neuropathy Scale-TCSS) and nerve conduction studies completed the Romanian version of PDQ-39. results. Significant differences between mean scores in Motor (49.86 (27.61) vs. 31.50 (26.24), p = 0.005), Activities of daily living (49.86 (27.61) vs. 31.75 (30.10), p = 0.003) and body discomfort (52.54 (29.54) vs. 23.64 (18.48), p = 0.002) domains of PDQ-39 in the PN-PD group versus non-PN group were observed. TCSS significantly correlated to motor, emotional well-being and body discomfort domains (r = 0.406 p< 0.001; r = 0.316 p = 0.007; r = 0.356 p = 0.002, respectively). The multivariate linear regression model showed that motor impairment and PN correlated to motor domain (beta = 0.601, p = 0.000; beta = 0.211 p = 0.041, respectively) and PN significantly correlated to body discomfort domain (beta = 0.314, p = 0.020) of PDQ-39. conclusions. The presence of associated PN in PD determines a further deterioration of HrQol in subjects with already a poorer HrQol.

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