Levodopa Induced Motor Complications in Thai Parkinson’s Disease Patients
Kongkiat Kulkantrakorn MD*, Somsak Tiamkao MD**, Chatlert Pongchaiyakul MD**, Teeratorn Pulkes MD, PhD***
Affiliation : * Faculty of Medicine, Thammasat University ** Faculty of Medicine, Khon Kaen University, Khon Kaen *** Department of Medicine, Ramathibodi Hospital, Mahidol University
Background : Long-term levodopa usage in Parkinson’s disease (PD) patients is known to cause several
motor complications. It may be related to several factors such as levodopa dosage, duration of treatment and
severity of disease.
Objective : To study the prevalence of levodopa motor complications and associated factors in Thai Parkinson’s
disease patients.
Materials and Methods : The authors prospectively collected baseline characteristics of PD patients, details of
treatment and complications from 3 hospitals in various parts of Thailand. These patients were diagnosed by
UK PD Brain Bank criteria.
Results : A total of 154 patients aged 68.1 (cid:31) 9.5 years were recruited. Age of onset was 61.2 (cid:31) 9.8 years. Most
patients were in Hoehn-Yahr stage 1-3. The common clinical features were bradykinesia, rigidity and resting
tremor. Treatments were levodopa (98.1 per cent), anticholinergic (29.9 per cent), dopamine agonists (26 per
cent) and COMT inhibitor (9.1 per cent). Eighty-five per cent of the patients had excellent response to
levodopa. However, 25 per cent of patients developed motor complications, which were wearing off (79 per
cent), on-off fluctuation (45 per cent), freezing (42 per cent), morning dyskinesia (10.5 per cent) and
permanent dyskinesia (23.7 per cent). Twelve patients developed severe levodopa induced chorea. Factors
associated with levodopa side effects were earlier age of onset, long duration of disease, advanced stage,
higher levodopa dosage and long duration of levodopa treatment. In the present study, age of onset was
inversely correlated with H-Y stage, while dosage of levodopa was positively correlated with H-Y stage but
inversely correlated with lower ADL score, which may be due to advanced disease state.
Conclusion : Levodopa motor complications are common in Thai PD patients. Wearing off, on-off fluctuation
and freezing are common forms of motor complications.
Keywords : Levodopa, Parkinson’s disease, Thailand, Motor complications
