The modern pre-levodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa

摘要: During the past decade, a number of large drug trials suggested that initiation levodopa therapy should be delayed to reduce risk motor complications in patients with Parkinson's disease. However, relative contribution cumulative exposure and disease progression pathophysiology fluctuations dyskinesias is still poorly understood. In this 4-year multicentre study, we investigated cohort sub-Saharan African country (Ghana), where access medication limited often occurs many years after onset. The primary objective was investigate whether occurrence primarily related duration or disease-related factors. Study design included cross-sectional case-control analysis data collected between December 2008 November 2012, prospective study followed-up for at least 6 months therapy. Ninety-one fulfilled criteria clinical diagnosis idiopathic (58 males, mean age onset 60.6 ± 11.3 years). Demographic were compared those 2282 consecutive Italian recruited during same period, whereas nested matched subgroups used compare variables. features, frequency severity non-motor symptoms comparable two populations, only exception more frequent tremor-dominant presentation Ghana. At baseline, proportion Ghanaian 56% 14%, respectively. Although introduced later Ghana (mean 4.2 2.8 versus 2.4 2.1 years, P < 0.001), similar populations. multivariate analysis, daily dose (mg/kg body weight) associated complications, while not. Prospective follow-up 2.6 1.3 subgroup 21 who drug-naive baseline [median 4.5 (interquartile range, 2.3-5) years] revealed median time development months. We conclude are not therapy, but rather longer higher dose. Hence, practice withhold delaying justified.