• Carolin Curtze, John G Nutt, Patricia Carlson-Kuhta, Martina Mancini, and Fay B Horak.
• Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
• Mov. Disord. 2015 Sep 1; 30 (10): 1361-70.

BackgroundThe effects of levodopa on balance and gait function in people with Parkinson's disease (PD) is controversial. This study compared the relative responsiveness to l-dopa on six domains of balance and gait: postural sway in stance; gait pace; dynamic stability; gait initiation; arm swing; and turning in people with mild and severe PD, with and without dyskinesia.MethodsWe studied 104 subjects with idiopathic PD (H & Y II [n = 52] and III-IV [n = 52]) and 64 age-matched controls. Subjects performed a mobility task in the practical off state and on l-dopa: standing quietly for 30 seconds, initiating gait, walking 7 meters, and turning 180 degrees. Thirty-four measures of mobility were computed from inertial sensors. Standardized response means were used to determine relative responsiveness to l-dopa.ResultsThe largest improvements with l-dopa were found for arm swing and pace-related gait measures. Gait dynamic stability was unaffected by PD and not responsive to l-dopa. l-dopa reduced turning duration, but only in subjects with severe PD. In contrast to gait, postural sway in quiet standing increased with l-dopa, especially in the more severely affected subjects. The increase in postural sway, as well as decrease in turning duration and exaggerated arm swing with l-dopa was observed only for subjects with dyskinesia at the time of testing.ConclusionsThe observed spectrum of l-dopa responsiveness in balance and gait measures suggests that multiple neural circuits control balance and gait. Many of the negative effects of l-dopa may be directly or indirectly caused by dyskinesia.© 2015 International Parkinson and Movement Disorder Society.

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