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Which dyskinesia scale best detects treatment response?
Article first published online: 6 FEB 2013
Copyright © 2012 Movement Disorder Society
Volume 28, Issue 3, pages 341–346, March 2013
How to Cite
Goetz, C. G., Stebbins, G. T., Chung, K. A., Hauser, R. A., Miyasaki, J. M., Nicholas, A. P., Poewe, W., Seppi, K., Rascol, O., Stacy, M. A., Nutt, J. G., Tanner, C. M., Urkowitz, A., Jaglin, J. A. and Ge, S. (2013), Which dyskinesia scale best detects treatment response?. Mov. Disord., 28: 341–346. doi: 10.1002/mds.25321
Funding agencies: The trial was sponsored by a grant from the Michael J. Fox Foundation for Parkinson's Research. The Rush Movement Disorder Program is also supported by the Parkinson's Disease Foundation.
Relevant conflicts of interest/financial disclosures: Christopher G. Goetz, John G. Nutt, and Glenn T. Stebbins participated in the development of the UDysRS. Christopher G. Goetz and Glenn T. Stebbins participated in the development of the RDRS. Robert A. Hauser participated in the development of the dyskinesia diaries used in this study.
- Issue published online: 21 MAR 2013
- Article first published online: 6 FEB 2013
- Manuscript Accepted: 15 NOV 2012
- Manuscript Revised: 8 NOV 2012
- Manuscript Received: 4 SEP 2012
- Parkinson's disease;
- rating scales;
- clinical trials
Numerous scales assess dyskinesia in Parkinson's disease (PD), variably focusing on anatomical distribution, phenomenology, time, severity, and disability. No study has compared these scales and their relative ability to detect change related to an established treatment. We conducted a randomized placebo-controlled trial of amantadine, assessing dyskinesia at baseline and at 4 and 8 weeks using the following scales: Unified Dyskinesia Rating Scale (UDysRS), Lang-Fahn Activities of Daily Living Dyskinesia Rating Scale (LF), 26-Item Parkinson's Disease Dyskinesia scale (PDD-26), patient diaries, modified Abnormal Involuntary Movements Scale (AIMS), Rush Dyskinesia Rating Scale (RDRS), dyskinesia items from the Movement Disorder Society–sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Clinical Global Impression (severity and change: CGI-S, CGI-C). Scale order was randomized at each visit, but raters were aware of each scale as it was administered. Sensitivity to treatment was assessed using effect size. Sixty-one randomized dyskinetic PD subjects (31 amantadine, 30 placebo) completed the study. Four of the 8 scales (CGI-C, LF, PDD-26, and UDysRS) detected a significant treatment. The UDysRS Total Score showed the highest effect size (η2 = 0.138) for detecting treatment-related change, with all other scales having effect sizes < 0.1. No scale was resistant to placebo effects. This study resolves 2 major issues useful for future testing of new antidyskinesia treatments: among tested scales, the UDysRS, having both subjective and objective dyskinesia ratings, is superior for detecting treatment effects; and the magnitude of the UDysRS effect size from amantadine sets a clear standard for comparison for new agents. © 2012 Movement Disorder Society