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NEUROLOGY 2007;68:1455-1459
© 2007 American Academy of Neurology

Acute vs chronic effects of l-dopa on bladder function in patients with mild Parkinson disease

L. Brusa, MD, PhD, F. Petta, MD, A. Pisani, MD, V. Moschella, MD, C. Iani, MD, P. Stanzione, MD, R. Miano, MD and E. Finazzi-Agrò, MD

From Clinica Neurologica (L.B., A.P., V.M.), Clinica Urologica (F.P., R.M., E.F.A.), Università di Roma Tor Vergata, Roma; UOC Neurologia, Ospedale S. Eugenio, Roma (L.B., C.I.); and I.R.C.C.S. Fondazione S. Lucia, Roma (A.P., P.S.), Italy.

Address correspondence and reprint requests to Dr. Paolo Stanzione, Clinica Neurologica, Università Tor Vergata Roma, Viale Oxford 81, 00100 Roma, Italy stanzione{at}med.uniroma2.it

Objective: To compare acute and chronic effects of l-dopa on bladder function in levodopa-naive Parkinson disease (PD) patients who had urinary urgency.

Methods: We evaluated 26 l-dopa–naive PD patients at a university-based PD center with a first urodynamic session with a double examination: in the off treatment condition and 1 hour after acute challenge with carbidopa/l-dopa 50/200 mg; then, a chronic l-dopa monotherapy was administered (mean dose 300 ± 150 mg). Two months later, patients underwent a second urodynamic session with a single evaluation 1 hour after the acute carbidopa/l-dopa challenge.

Results: The first acute l-dopa challenge significantly worsened bladder overactivity (neurogenic overactive detrusor contractions threshold [NDOC-t; 32% of worsening] and bladder capacity [BC; 22% of worsening]); on the contrary, l-dopa challenge during chronic administration ameliorated the first sensation of bladder filling (FS; 120% of improvement), NDOCT-t (93% improvement), and BC (33% of improvement) vs the values obtained with acute administration. An 86% significant improvement of FS in comparison with the basal value was observed.

Conclusions: The acute and chronic l-dopa effects may be due to the different synaptic concentrations or to the activation of postsynaptic mechanisms obtained by chronic administration.

Received June 29, 2006. Accepted in final form December 31, 2006.




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