Predictors of dyskinesia in Parkinson.

IMotor complications like dyskinesias and fluctuations pose a major challenge in the medical management of Parkinson's disease. This study evaluated various motor complications and the factors contributing to their occurrence. Two hundred ninety three consecutive subjects (230 males and 63 females) with a mean age of 53.41(SD 11.24) years were recruited over a 2 year period. All patients were interviewed for information regarding clinical features, complications of disease and treatment details by neurologists. The predictive factors of dyskinesias and on-off phenomenon were ascertained using univariate and multi-variate (binomial logistic regression) analysis. Dyskinesias were reported in 57 patients (19.6%) and on- off phenomenon in 100 (34.2%) patients. The main type of dyskinesia observed was peak-dose (improvement-dyskinesia-improvement) dyskinesia. The important factors contributing to dyskinesias after multivariate analysis were young age of onset (< 40 years), presence of wearing-off and freezing episodes (ORs of 2.33,19.12 and 3.41 respectively), while tremor-dominant phenotype was associated with a lower risk of dyskinesias (OR 0.45). Cumulative dose of levodopa and/or dopa-agonist also showed significant association when considered along with the age of onset (OR 2.45). The factors associated with occurrence of on-off phenomenon were UPDRS motor score , freezing episodes, levodopa use (as opposed to dopa agonists), cumulative dose of levodopa and initial response to levodopa (OR 2.92, 3.00, 13.24, 2.91 and 0.28 respectively). This study helps to understand clinical features associated with motor complications; the recognition of which may have therapeutic and prognostic implications. [ABSTRACT FROM AUTHOR]