Background and objective

Levodopa off/on testing is frequently performed to assess medication response in patients with Parkinson’s disease (PD) as an aid in determining best medical management or potential surgical candidacy. The Parkinson’s Kinetigraph (PKG) is a wearable device which generates tremor, bradykinesia (BKS) and dyskinesia (DKS) scores representing motor symptoms over a six-day period. In this study, we compared off/on testing with PKG motor scores.

Methods

Patients were enrolled as part of an observational study: Assessing the Longitudinal Signs in PD, a three-year study evaluating clinical and biomarker evolution in patients with PD taking levodopa. Patients underwent off/on testing at baseline and 6-month visits. A greater than 30% improvement between off and on MDS-Unified Parkinson’s Disease Rating Scale scores was considered a robust response. After each visit, patients wore the PKG for 6 days. A bradykinesia score (BKS) greater than 26 and dyskinesia score (DKS) greater than 9 were considered poorly controlled bradykinesia and dyskinesia, respectively.

Results

The median BKS at the baseline and 6-month visits were 27.15 and 27.55, respectively, despite a robust median off/on improvement at both visits. In addition, 10/18 (66%) and 7/13 (53.8%) patients with robust off/on improvement at the baseline and 6-month visits, respectively, demonstrated a BKS > 26 or DKS > 9.

Conclusion

A robust off/on response during a clinic visit does not necessarily reflect adequately controlled motor symptoms. The PKG, by virtue of its continuous recording of motor movements, may provide additional clinically relevant data on motor symptoms which may be useful for prospective observational studies.

中文翻译：

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帕金森 KinetiGraph 与关闭/开启左旋多巴反应测试的比较：单中心体验

背景和目标

左旋多巴开/关测试经常用于评估帕金森病 (PD) 患者的药物反应，以帮助确定最佳医疗管理或潜在的手术候选资格。帕金森运动记录仪 (PKG) 是一种可穿戴设备，可产生震颤、运动迟缓 (BKS) 和运动障碍 (DKS) 分数，代表六天期间的运动症状。在这项研究中，我们将关闭/开启测试与 PKG 运动评分进行了比较。

方法

患者被纳入一项观察性研究：评估 PD 的纵向体征，这是一项为期三年的研究，评估服用左旋多巴的 PD 患者的临床和生物标志物演变。患者在基线和 6 个月就诊时接受了关/开测试。MDS-统一帕金森病评定量表评分在停用和启用之间有超过 30% 的改善被认为是一种强有力的反应。每次就诊后，患者佩戴 PKG 6 天。运动迟缓评分 (BKS) 大于 26 和运动障碍评分 (DKS) 大于 9 分别被认为是控制不佳的运动迟缓和运动障碍。

结果

基线和 6 个月就诊时的中位 BKS 分别为 27.15 和 27.55，尽管两次就诊的中位开/关都有明显改善。此外，分别有 10/18 (66%) 和 7/13 (53.8%) 的患者在基线和 6 个月就诊时有明显的开/关改善，BKS > 26 或 DKS > 9。

结论

门诊就诊期间的强烈关闭/开启反应不一定反映充分控制的运动症状。PKG 凭借其对运动运动的连续记录，可以提供有关运动症状的额外临床相关数据，这可能对前瞻性观察研究有用。