Rigidity in Parkinson's Disease: The Objective Effect of Levodopa

IF 7.6 1区医学 Q1 CLINICAL NEUROLOGY Movement Disorders Pub Date : 2025-01-08 DOI:10.1002/mds.30114

Marco Falletti MD, Francesco Asci MD, PhD, Alessandro Zampogna MD, Martina Patera MD, Giulia Pinola MD, Diego Centonze MD, PhD, Mark Hallett MD, PhD, John Rothwell MD, PhD, Antonio Suppa MD, PhD

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Abstract

Background

Quantitative evidence of levodopa-induced beneficial effects on parkinsonian rigidity in Parkinson's disease (PD) is lacking. Recent research has demonstrated the velocity-dependent nature of objective rigidity in PD and revealed its neural underpinning.

Objective

The present study aimed to examine the effect of levodopa on objective rigidity in PD.

Methods

Eighteen patients with PD underwent clinical and instrumental evaluations of muscle tone in the OFF and ON states. The clinical assessments focused on rigidity in the most affected upper limb. The biomechanical components of objective rigidity were assessed using robot-assisted wrist extensions at seven angular velocities (5–280°/s). Surface electromyography of the flexor carpi radialis muscle enabled the concurrent evaluation of short- and long-latency stretch reflexes (SLR and LLR).

Results

Levodopa improved the clinical scores of rigidity. Biomechanical measurements showed that levodopa reduced the total and neural components of force but had no effect on viscoelastic components. Levodopa reduced the velocity dependence of the LLRs but did not affect the SLRs. Finally, we found significant clinical–instrumental correlations between levodopa-induced changes and biomechanical and neurophysiological measures of objective rigidity in PD.

Conclusions

Levodopa improved objective rigidity in PD by decreasing its biomechanical neural component as well as the size of LLRs. The beneficial effect of levodopa on biomechanical and neurophysiological features of objective rigidity was related to the specific angular velocity of wrist extensions; that is, the higher the angular velocity, the greater the beneficial impact of levodopa on objective rigidity. These findings allowed the description of a new pathophysiological model of rigidity in PD. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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帕金森病的僵硬：左旋多巴的客观作用。

背景：左旋多巴诱导的对帕金森病（PD）帕金森僵硬的有益作用的定量证据尚缺乏。最近的研究表明PD客观刚性的速度依赖性，并揭示了其神经基础。目的：探讨左旋多巴对帕金森病患者客观刚性的影响。方法：对18例PD患者进行了OFF和ON状态下的肌肉张力的临床和仪器评估。临床评估的重点是受影响最严重的上肢僵硬。采用机器人辅助手腕伸展，以7个角速度（5-280°/s）评估客观刚性的生物力学成分。桡侧腕屈肌的表面肌电图可以同时评估短潜伏期和长潜伏期拉伸反射（SLR和LLR）。结果：左旋多巴改善了临床僵硬评分。生物力学测量表明，左旋多巴降低了总力和神经力，但对粘弹性力没有影响。左旋多巴降低了lrs的速度依赖性，但对SLRs没有影响。最后，我们发现左旋多巴诱导的改变与PD患者客观刚性的生物力学和神经生理指标之间存在显著的临床-仪器相关性。结论：左旋多巴通过降低PD的生物力学神经成分和llr的大小来改善PD的客观刚性。左旋多巴对客观刚性的生物力学和神经生理特征的有益影响与手腕伸展的比角速度有关；即角速度越高，左旋多巴对客观刚性的有利影响越大。这些发现允许描述一种新的PD僵硬的病理生理模型。©2025作者。Wiley期刊有限责任公司代表国际帕金森和运动障碍学会出版的《运动障碍》。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.