Drs. Ceravolo, Cossu, Abbruzzese, and Bonuccelli contributed equally to this article.
Neuropathy and levodopa in Parkinson's disease: Evidence from a multicenter study
Article first published online: 8 JUL 2013
© 2013 International Parkinson and Movement Disorder Society
Volume 28, Issue 10, pages 1391–1397, September 2013
How to Cite
Ceravolo, R., Cossu, G., Bandettini di Poggio, M., Santoro, L., Barone, P., Zibetti, M., Frosini, D., Nicoletti, V., Manganelli, F., Iodice, R., Picillo, M., Merola, A., Lopiano, L., Paribello, A., Manca, D., Melis, M., Marchese, R., Borelli, P., Mereu, A., Contu, P., Abbruzzese, G. and Bonuccelli, U. (2013), Neuropathy and levodopa in Parkinson's disease: Evidence from a multicenter study. Mov. Disord., 28: 1391–1397. doi: 10.1002/mds.25585
Relevant conflicts of interest/financial disclosures: Nothing to report.
Full financial disclosures and author roles may be found in the online version of this article.
- Issue published online: 23 SEP 2013
- Article first published online: 8 JUL 2013
- Manuscript Accepted: 23 MAY 2013
- Manuscript Revised: 13 MAY 2013
- Manuscript Received: 2 NOV 2012
- Parkinson's disease;
- peripheral neuropathy
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