Improvement of gait by chronic high doses of methylphenidate in advanced parkinsonian patients
Abstract
Background: Therapeutic management of gait disorders in very advanced Parkinson’s disease (PD) patients can sometimes be disappointing, since dopaminergic drug treatments and subthalamic nucleus (STN) stimulation are more effective for limb-related parkinsonian signs than for gait disorders. Gait disorders could be also partly related to noradrenergic system impairment, pharmacological modulation of both dopamine and noradrenaline pathways could potentially improve the symptomatology.
Methods: We assessed the clinical value of chronic, high doses of methylphenidate (MPD) in PD patients suffering from gait disorders despite their use of optimal dopaminergic doses and STN stimulation parameters. Efficacy was blindly assessed on video for 17 patients in the absence of L-Dopa and again after acute administration of the drug, both before and after a 3-month course of MPD, using a Stand Walk Sit test (SWS), the Tinetti scale, the UPDRS part III score and the dyskinesia rating scale.
Findings: We saw an improvement in the number of steps and time in the SWS, the number of freezing episodes, the Tinetti scale score and the part III UPDRS score in the absence of L-Dopa after 3 months on MPD. The L-Dopa-induced improvement in these various scores was also stronger after the 3-month course of MPD than before. The Epworth Sleepiness Scale score fell dramatically in all patients. No significant induction of adverse effects was found.
Interpretation: Chronic, high doses of MPD improved gait and motor symptoms in the absence of L-Dopa and increased the intensity of response of these symptoms to L-Dopa in advanced PD population.
