Nearly half of patients with Parkinson's disease develop motor fluctuations after a period of time in treatment with levodopa (between 4-6 years after onset of treatment). Apparently these fluctuations are caused by the decrease of the response to the medication (regularly called response sub-optimal, i.e. below what we expect).
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| Parkinsonism and Related Disorders |
These motor fluctuations or changes in response to dopaminergic drugs manifested by episodes in which the symptoms of the disease reappear.
In this way, we can define "on" periods where motor function is normal, and "off" periods in which appear the motor symptoms of the disease and hyperkinetic movements may appear involuntary (dyskinesias).
The phenomenon "wearing-off" or 'end-of-dose deterioration', is one in which the symptoms of Parkinson's disease reappear before you receive the next dose of the drug. With this last type of fluctuations the patient becomes dose-dependent and requires an increase in the frequency of the dose with shorter intervals.
This phenomenon "deterioration in end-of-dose"(wearing-off), is very different from one subject to another, and its early detection allows to optimize the treatment.
The reasons why this phenomenon occurs are not fully known. They have been recognized as risk factors: age of onset of symptoms, low body weight, the severity of the disease, the Association of levodopa and Entacapone, a single daily intake of levodopa, the duration of treatment with levodopa and the female gender.
One study evaluated the differences between genders (male/female) and is based on an analysis that was carried out in Italy in 600 people with Parkinson's disease.
In this study, it is revealed that women are more likely to suffer the phenomenon of 'end-of-dose deterioration' in comparison with the men, arriving at a risk of 80 percent of women with Parkinson's disease who suffer it.
Furthermore, women experience this phenomenon in a shorter period of time than men and the progression of the disease, is also slightly faster.
The differences between men and women in relation to the response to treatment has already had shown previously, such is the case of the emergence of i.e., levodopa-induced dyskinesias dyskinesias are more frequent in women when the disease lasts 5 years and with one latency of less than men.
The results of this study as well as providing an explanation of the association with the female gender, would put emphasis on a parameter such as body weight, which in clinical practice usually is overlooked when it comes to therapeutic decisions.
The women reported a poorer quality of life than men, probably because of the 'end-of-dose deterioration' phenomenon since the emergence of motor and non-motor symptoms is correlated with the quality of life.
According to guide them in the treatment of Parkinson's disease symptomatic control of the phenomenon "end-of-dose deterioration" is made by increasing and/or fractionation of levodopa dose or adding other drugs.
Although clinical guidelines for the management of Parkinson's disease does not contemplate a different treatment approach between géneros(hombre/mujer), evidence of a different response, suggests the need for more attention in the daily clinical management.
Conclusion
A difference between men and women in the presentation of the phenomenon there may be 'end-of-dose deterioration' in people with Parkinson's disease and this can have implications of treatment below the optimal dose for control of the disease.
This draws attention to the desirability of a treatment approach personalized especially for women with Parkinson's disease who normally are poorly represented in the studies.
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