[Optimal time for beginning treatment with levodopa]

Because an optimal time for beginning treatment with levodopa is not clarified so far, an aim of the study was to specify key risk factors for the development of motor fluctuations and dyskinesias and to study correlations between their manifestation and time for beginning treatment with levodopa. Forty patients (mean age 57,86+/-8,02 years; mean illness duration 6,38+/-3,2 years) with Parkinson's disease (PD) with phenomenon of "dose exhaustion' were included. Spearman correlation analysis was used to assess correlations between the development of movement disorders and clinical features of PD. Effects of different variables on fluctuations and dyskinesias were calculated using discrimination analysis. If the treatment with levodopa was started during the first four years after disease onset, the phenomenon of "dose exhaustion' developed on average after 4,6+/-2,4 years. In case of beginning the treatment during five and more years after PD onset, signs of motor fluctuations manifested after 2,26+/-1,56 years (p< or =0,05). The stage of disease predicted the development of motor fluctuations, while the daily dose of levodopa and stage of disease predicted the development of dyskinesias. It has been concluded, that disease severity and its impact on daily activities of a patient, but not potential risk of fluctuations and dyskinesias, should be first of all taken into account in the choice of therapeutic tactics.