Long Duration Response in Parkinson's Disease: Levodopa Revisited

Werner Poewe; Alberto J. Espay


Brain. 2020;143(8):2332-2335. 

In This Article

On the 'Non-dopaminergic' Motor Features

It has become common usage in the literature on the treatment of Parkinson's disease to label certain motor features as 'non-dopaminergic' implying that they usually do not respond to levodopa or other dopaminergic drugs. These include dysarthria, postural instability or deformity, freezing of gait, and falls, among others. Cilia and colleagues used a published 'non-dopaminergic' item subscore of the UPDRS and found sustained levodopa-related improvement over 2 years in these motor features. This is consistent with the clinical experience of every neurologist initiating levodopa in a subject with Parkinson's disease who will regularly experience marked improvement of speech, posture and gait and questions the appropriateness of the term 'non-dopaminergic' for these motor features. Most if not all of these do respond to levodopa for years, although with progression they often deteriorate to an extent no longer amenable to treatment.