OPTIMIZATION THE TREATMENT OF MOTOR FLUCTUATIONS VARIOUS FORMS OF PARKINSON’S DISEASE

Abstract

. Levodopa is the gold standard for the treatment of Parkinson’s disease. Motor fluctuations and dyskinesia are important complications of levodopa therapy that affect many patients with Parkinson’s disease. The aim of our study was to determine the nature of motor fluctuations and optimize the treatment approach for various forms of Parkinson’s disease. We examined 80 patients with Parkinson’s disease who were undergoing examination and inpatient treatment in the neurological department of the Poltava Regional Clinical Hospital named after M.V. Sklifosovsky and on the basis of the Center for patients with Parkinson’s disease and other neurodegenerative diseases on the basis of the Department of Nervous Diseases of the Poltava State Medical University. All patients included in the study were treated with levodopa drugs. Depending on levodopa therapy, patients were divided into subgroups: a subgroup – patients received therapy with short-acting levodopa drugs 4 times a day. b subgroup – patients received combined short-acting levodopa 3 times per day with extended-acting levodopa before sleep.The patients with akinetiс-rigid form has more severe motor disturbances and lower level of independence. These differences cause finding method for optimization of treatment with considering motor forms of Parkinson’s disease. Among the motor complications encountered in patients with various forms of Parkinson’s disease, the following prevailed: the phenomenon of “wearing out”, unpredictable periods of disconnection, freezing, insufficient “switching on”. It was shown that in patients with rigidity form combined therapy significantly decreased duration “off” period, improved UPDRS-III) and Schwab and England scores, when in group with akinetic-rigidity-tremor form it only decreases UPDRS-III score. In the course of the treatment, a significant improvement in the clinical symptoms and reduction of motor complications were observed in Parkinson’s disease patients receiving treatment using combined levodopa therapy (a combination of short-acting levodopa and long-acting levodopa). we have shown better response for changing treatment strategy in patients with rigidity forms of disease. We can recommend to consider adding of long-release levodopa for management of motor complications in Parkinson’s disease patients with rigidity and akinetic-rigid and tremor-dominant forms of Parkinson’s disease.

Keywords

• parkinson’s disease,motor fluctuationы,optimization of treatment.