Differential features of PD patients with DDS according to clinical outcome
| DDS | Total (n=35) | Remission (n=14) | Persisting (n=21) | p Values |
|---|---|---|---|---|
| Disease duration at DDS onset, years | 10.9 (3.5) | 10.3 (4.0) | 11.4 (3.0) | 0.4 |
| Patient Follow-Up, years | 3.2 (2.1) | 3.8 (2.3) | 3.5 (3.1) | 0.77 |
| Impulse Control Disorders (n (%)) | 23 (66) | 12 (86) | 11 (52) | 0.07 |
| Subjective feeling the ‘high’ (n (%)) | 8 (23) | 2 (14) | 6 (28) | 0.68 |
| Education | 10.6 (5.6) | 10.8 (6.8) | 9.9 (4.6) | 0.67 |
| Poor caregiving (n (%)) | 14 (40) | 2 (14) | 12 (57) | 0.016 |
| LEDD at last F-U (mean mg/day (SD)) | 1631 (1564) | 1061 (574) | 2344 (2090) | 0.031 |
| LEDD reduction at last F-U (mean mg/day (SD), %) | 639.8 (1008) | 1271 (1344), 55.4% | 245.4 (281), 14.4% | 0.02 |
| Δ UPDRS part III ‘Off’—‘On’ | 23.4 (6.7) | 21.7 (7.1) | 25.2 (5.9) | 0.14 |
| UPDRS part IV—Dyskinesias (items 32-to-35) | 3.5 (1.7) | 2.2 (1.0) | 4.3 (1.6) | <0.01 |
| DDS pattern | ||||
| Compulsive Levodopa intake (n (%)) | 32 (91.4) | 12 | 20 | 0.72 |
| Compulsive DA agonist intake (n (%)) | 3 (8.6) | 2 | 1 | N.S. |
| Apomorphine s.c. rescue boli (n/day) | 6 | 1 | 5 | 0.38 |
| DDS management | ||||
| Optimisation of DRT | ||||
| Add MAO-B inhibitors (n) | 4 | 2 | 2 | 0.62 |
| Add COMT inhibitor (n) | 4 | 2 | 2 | 0.62 |
| Entacapone switched to Tolcapone (n) | 8 | 3 | 5 | 0.98 |
| Advanced stage treatment (n (%)) | 17 (49) | 7 | 10 | 0.20 |
| CAI/STN-DBS/DLI (n) | 8/8/5* | 0/3/4 | 8/5/1 | N.S. |
| DLI (% of treatments) | 24% | 57% | 10% | 0.06 |
| Antipsychotic therapy (n (%)) | 23 (66) | 10 (71) | 13 (62) | 0.72 |
| Quetiapine/Clozapine/Others† | 12/8/3 | 4/6/0 | 8/2/3 | N.S. |
| Clozapine (total %) | 33% | 60% | 15% | 0.04 |
| Antidepressants (n (%)) | 11 (31) | 5 (36) | 6 (29) | 0.71 |
| SSRI/SNRI/TCA | 8/3/0 | 4/1/0 | 5/2/0 | N.S. |
| Mood stabilisers (n (%)) | 2 (6) | 0 (0) | 2 (9) | 0.52 |
| Psychological interventions (n (%)) | 6 (17) | 3 (21) | 3 (14) | 0.65 |
Significant p values (<0.05) are highlighted in bold.
Reduction of dopaminergic therapy total daily dosage at the last follow-up (F-U) compared to baseline has been reported as mean LEDD (SD) and relative percentage.
*Patients with more than one advanced-stage treatment (n=4): CAI and subsequent DLI, n=3; CAI and subsequent STN-DBS, n=1.
†Patients treated with haloperidol (n=1), olanzapine (n=1), risperidone (n=1).
CAI, continuous apomorphine infusion; DA, dopamine; DDS, dopamine dysregulation syndrome; DLI, duodenal levodopa infusion; DRT, Dopamine replacement therapy; LEDD, levodopa-equivalent daily dose; SSRI, selective serotonin re-uptake inhibitors; STN-DBS; subthalamic nucleus deep brain stimulation; UPDRS, Unified Parkinson Disease Rating Scale.