Discinesias induzidas por levodopa em 176 pacientes com doença de Parkinson

Maria Sheila G. RochaI; Luiz Augusto F. AndradeII; Henrique B. FerrazIII; Vanderci BorgesI
IPós-graduanda em Neurologia. Setor de Investigação em Moléstias Extrapiramidais da Disciplina de Neurologia Clínica Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo, São Paulo IIProfessor Livre Docente, Chefe do Setor. Setor de Investigação em Moléstias Extrapiramidais da Disciplina de Neurologia Clínica Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo, São Paulo IIIDoutor em Neurologia, Médico do Setor de Investigação em Moléstias Extrapiramidais da Disciplina de Neurologia Clínica Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo, São Paulo
RESUMO
A ocorrência de discinesias dificulta consideravelmente o manuseio terapêutico dos pacientes parkinsonianos tratados com levodopa. Estudamos as características clínicas das discinesias em 176 pacientes com diagnóstico de doença de Parkinson e tratados com levodopa. As discinesias ocorreram, em média, após 6,2 anos de duração da doença e após 4,2 anos de tratamento com levodopa. A maioria dos pacientes (90%) achava-se nos estágios II e III de Hoehn & Yahr por ocasião do início das discinesias. As discinesias mais frequentes foram as de "pico de dose" e "contínua". Movimento do tipo distônico ocorreu em 40% dos casos e predominou nas discinesias de "fim de dose" e "bifásica". Distonia matinal correspondeu a 35% dos casos de distonia. Movimentos coreiformes se manifestaram de forma generalizada em 43,2% dos casos. Movimentos distônicos predominaram nos membros inferiores. A discinesia, quando unilateral, ocorreu mais frequüentemente no hemicorpo mais comprometido pela doença de Parkinson. A discinesia orofacial, quando isolada, foi mais frequente nos pacientes mais idosos.

Palavras-chave: doença de Parkinson, discinesias, levodopa
SUMMARY
Dyskinesias are frequently observed in parkinsonian patients during levodopa treatment. The occurrence of these movement disorders usually makes the therapeutic management of the patients very difficult. The clinical characteristics of 176 patients with dyskinesias were retrospectively studied. Dyskinesias occurred, on average, after 6,2 years of duration of Parkinson's disease and after 4.2 years on treatment with levodopa. Patients were more likely to have dyskinesias during more advanced stages (measured by Hoehn and Yahr scale). Peak of dose and square wave were the types of dyskinesia more frequently described and were associated with choreic movements in most cases. Dystonia occurred in 40% of the cases and was predominant in end of dose and diphasic dyskinesias. Thirty-five percent of dystonia cases presented as "early morning dystonia". Chorea was the most frequent involuntary movement and mostly generalized. Dystonia was most commonly described in lower limbs. Orofacial dyskinesia, when occurred alone, was more frequently seen in old rather than young patients. When dyskinesia was unilateral it was more likely to occur in the side where Parkinson's disease was more severe.
Key words: Parkinson's disease, dyskinesias, levodopa

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