RT Journal Article
SR Electronic
T1 Biphasic (Subtherapeutic) Levodopa-Induced Respiratory Dysfunction in Parkinson Disease
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP e402
OP e406
DO 10.1212/CPJ.0000000000001043
VO 11
IS 4
A1 Veerle A. van de Wetering-van Dongen
A1 Alberto J. Espay
A1 Luca Marsili
A1 Andrea Sturchio
A1 Susanne Ten Holter
A1 Bastiaan R. Bloem
A1 Maarten J. Nijkrake
YR 2021
UL http://cp.neurology.org/content/11/4/e402.abstract
AB Objective To evaluate 3 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 3 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, peak cough flow, and forced expiratory volume in 1 second.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 nonmotor phenomenon in PD. Management requires increasing the levodopa dose, shortening the interdose interval, or implementing a program of continuous dopaminergic stimulation.