Biphasic (Subtherapeutic) Levodopa-induced Respiratory Dysfunction in Parkinson Disease
Citation Manager Formats
Make Comment
See Comments

ABSTRACT
Objective To evaluated three cases illustrating a rarely recognized phenotype of Parkinson disease (PD), namely biphasic levodopa-induced respiratory dysfunction manifesting as dyspnea.
Methods To appreciate the nature of the fluctuations of respiratory function in response to levodopa, we measured changes in respiratory muscle control before and after the best therapeutic response to levodopa in three PD patients with fluctuating dyspnea.
Results Episodes of breathlessness were accompanied by shallow tachypnea and reduced respiratory muscle control, as measured by maximal expiratory pressure (MEP), peak cough flow (PCF), and Forced Expiratory Volume in 1 second (FEV1).
Conclusions The spectrum of respiratory dysfunction in PD includes a biphasic reduced respiratory muscle control accompanying periods when the effect of levodopa is subtherapeutic. This biphasic levodopa-related complication represents a rarely recognized non-motor phenomenon in PD. Management requires increasing the levodopa dose, shortening the interdose interval, or implementing a program of continuous dopaminergic stimulation.
- Received September 2, 2020.
- Accepted November 19, 2020.
- © 2021 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
The Nerve!: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Sevil Yaşar and Dr. Behnam Sabayan
► Watch
Related Articles
- No related articles found.
Topics Discussed
Alert Me
Recommended articles
-
Article
The scientific and clinical basis for the treatment of Parkinson disease (2009)C. Warren Olanow, Matthew B. Stern, Kapil Sethi et al.Neurology, May 26, 2009 -
Article
DMPK gene DNA methylation levels are associated with muscular and respiratory profiles in DM1Cécilia Légaré, Gayle Overend, Simon-Pierre Guay et al.Neurology: Genetics, May 23, 2019 -
Article
X-linked myotubular myopathyA prospective international natural history studyMélanie Annoussamy, Charlotte Lilien, Teresa Gidaro et al.Neurology, March 22, 2019 -
Articles
An algorithm (decision tree) for the management of Parkinson’s disease (2001):Treatment GuidelinesC. Warren Olanow, Ray L. Watts, William C. Koller et al.Neurology, June 12, 2001