Neuropathy and levodopa in Parkinson's disease: Evidence from a multicenter study |
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| Authors: | Lucio Santoro MD Paolo Barone MD Maurizio Zibetti MD Daniela Frosini MD Valentina Nicoletti MD Fiore Manganelli MD Rosa Iodice MD Marina Picillo MD Aristide Merola MD Leonardo Lopiano MD Alessandra Paribello MD Davide Manca MD Maurizio Melis MD Roberta Marchese MD Paolo Borelli MD Alessandra Mereu BS PhD Paolo Contu MD PhD Ubaldo Bonuccelli MD |
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| Institution: | 1. Department of Neurological Sciences, University Federico II of Napoli, , Napoli, Italy;2. Neurodegenerative Diseases Center, Department of Medicine, University of Salerno, , Salerno, Italy;3. IDC Hermitage‐Capodimonte, , Napoli, Italy;4. Neurology Unit, University of Torino, , Torino, Italy;5. Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, , Pisa, Italy;6. Neurology Unit, Azienda Ospedaliera Brotzu Cagliari, , Cagliari, Italy;7. Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, , Genova, Italy;8. Neurology Unit, Versilia Hospital, , Lido di Camaiore, Italy;9. Department of Public Health University, Clinical and Molecular Medicine, University of Cagliari, , Cagliari, Italy |
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| Abstract: | The objectives of this study were to evaluate the risk of neuropathy in patients with Parkinson's disease (PD) and to evaluate the role of levodopa exposure as a potential risk factor. A multicenter study of 330 patients with PD and 137 healthy controls with a comparable age distribution was performed. With respect to levodopa exposure, 144 patients had long exposure (≥3 years) to levodopa (LELD), 103 patients had short exposure (<3 years) to levodopa (SELD), and 83 patients had no exposure to levodopa (NOLD). Nerve function was evaluated using the reduced total neuropathy score. Right sural sensory antidromic and peroneal motor nerve conduction studies were performed by neurophysiologists who were blinded to the existence of neuropathy clinical features or PD treatment. Overall, 19.40% of patients in the LELD group, 6.80% in the SELD group, 4.82% in the NOLD group, and 8.76% in the control group were diagnosed with neuropathy (axonal, predominantly sensory). Multivariate logistic analysis indicated that the risk of neuropathy was not influenced by disease duration, severity, or sex. The risk of neuropathy increased by approximately 8% for each year of age (P < 0.001; odds ratio OR], 1.08; 95% confidence interval CI], 1.037‐1.128). The risk of neuropathy was 2.38 higher in the LELD group than in the control group (P = 0.022; OR, 2.38; 95% CI, 1.130‐5.014). In a comparison between patients with and without neuropathy (Student's t test), the levodopa dose was higher (P < 0.0001), serum vitamin B12 levels were lower (P = 0.0102), and homocysteine levels were higher (P < 0.001) in the patients with neuropathy. Our results demonstrate that the duration of exposure to levodopa, along with age, is the main risk factor for the development of neuropathy. Screening for homocysteine and vitamin B12 levels and clinical‐neurophysiological monitoring for neuropathy may be advisable in patients with PD who are receiving treatment with levodopa. © 2013 International Parkinson and Movement Disorder Society |
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| Keywords: | Parkinson's disease peripheral neuropathy |
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