Abstract
Objective: To objectively compare the effects of levodopa response on gait and balance in patients with advanced Parkinson’s disease (PD).
Background: Bradykinesia, tremor and rigidity are generally well-controlled by levodopa; however, there is less consistency regarding the effect of levodopa on gait and balance. Standard clinical examinations for PD provide historical, subjective and often limited assessments of gait and balance.
Design/Methods: Gait and balance assessments as well as UPDRS, were performed in the medication ON and OFF states using the Mobility Lab System equipped with six wireless inertial sensors: two foot sensors, two wrist sensors, one lumbar sensor, and one trunk sensor (APDM, Inc., Portland, OR).
Results: Sixteen pre-DBS PD patients (14 males, 2 females), with a mean age of 64.7 years (±10.2 yrs, range 33–79 yrs), with an average disease duration of 10.4 years (±6.3 yrs) were included. UPDRS Motor scores were significantly improved (p<0.001) with levodopa (28.8±8.9 vs. 45.2±8.0). Gait parameters of speed, foot strike angle, and stride length were significantly greater in the ON state compared to the OFF state for both the left and right sides (p≤0.01). Arm range of motion was significantly greater in the ON state compared to the OFF state for the right side only (p<0.05). There was no improvement with levodopa in the gait parameters of cadence, step duration, or arm swing velocity (p>0.05). With respect to balance, lumbar range of motion in the coronal, sagittal, and transverse planes and trunk range of motion in the coronal and transverse planes were significantly greater when ON compared to OFF (p<0.05). Balance assessments of sway area and trunk range of motion in the sagittal plane were not improved with levodopa (p>0.05).
Conclusions: As measured by wireless inertial sensors, multiple aspects of gait and balance are improved with levodopa in advanced PD patients.
Study Supported by: Bowling Research Fund
Disclosure: Dr. Fowler has nothing to disclose. Dr. Gernon has nothing to disclose. Dr. Pahwa has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Abbvie, ACADIA, Acorda, Adamas, Cynapses, Global Kinetics, Lundbeck, Neurocrine, Pfizer, Sage, Sunovion, Teva Neuroscience and US World Meds. Dr. Pahwa has received research support from Abbvie, Adamas, Avid, Biotie, Boston Scientific, Civitas, Cynapses, Kyowa, National Parkinson Foundation, NIH/NINDS, Parkinson Study Group. Dr. Lyons has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with ACADIA, NPF, Sage. Dr. Lyons has received personal compensation in an editorial capacity for International Journal of Neuroscience / Taylor & Francis.
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