Expert review of neurotherapeutics · 2025
Effects of oral levodopa on motor symptoms and gait impairments in Parkinson's disease: a systematic review and meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Lillebæk Birk S, Tran Janni, Dalgas Ulrik, Langeskov-Christensen Martin
Аннотация
INTRODUCTION: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and gait impairments. Levodopa remains the cornerstone of pharmacological treatment. This review examined the acute effects of oral levodopa on motor symptoms and gait parameters in people with PD.
METHODS: PubMed and Embase were searched up to February 17th 2025. Included studies presented within-subject comparisons between ON- and OFF-medication states, assessing outcomes such as UPDRS motor scores, clinical walking tests, and spatiotemporal gait metrics. Study quality was assessed using the NIH quality assessment tool for before-after studies without control groups. Standardized mean changes (SMC) were calculated to quantify treatment effects. Studies with incomplete data were qualitatively reviewed.
RESULTS: Thirty-nine papers (38 studies; 1425 participants) were included. Levodopa significantly improved the (MDS)-UPDRS motor score (SMC = -1.49 [-1.77, -1.22]), corresponding to a mean decrease of -14.0 points [-16.7, -11.48]. Stride/step length (0.76 [0.44, 1.08]), gait velocity (0.75 [0.48, 1.01]), and clinical walking tests (-0.50 [-0.78, -0.21]) also improved. Effects on other gait characteristics (i.e., step width, stance/swing/step time, gait cycle duration, and swing/stance phase) were limited.
CONCLUSIONS: Oral levodopa induces substantial acute improvements in motor symptoms and key gait parameters but has limited effects on other gait characteristics, emphasizing the need for complementary and individualized interventions.
METHODS: PubMed and Embase were searched up to February 17th 2025. Included studies presented within-subject comparisons between ON- and OFF-medication states, assessing outcomes such as UPDRS motor scores, clinical walking tests, and spatiotemporal gait metrics. Study quality was assessed using the NIH quality assessment tool for before-after studies without control groups. Standardized mean changes (SMC) were calculated to quantify treatment effects. Studies with incomplete data were qualitatively reviewed.
RESULTS: Thirty-nine papers (38 studies; 1425 participants) were included. Levodopa significantly improved the (MDS)-UPDRS motor score (SMC = -1.49 [-1.77, -1.22]), corresponding to a mean decrease of -14.0 points [-16.7, -11.48]. Stride/step length (0.76 [0.44, 1.08]), gait velocity (0.75 [0.48, 1.01]), and clinical walking tests (-0.50 [-0.78, -0.21]) also improved. Effects on other gait characteristics (i.e., step width, stance/swing/step time, gait cycle duration, and swing/stance phase) were limited.
CONCLUSIONS: Oral levodopa induces substantial acute improvements in motor symptoms and key gait parameters but has limited effects on other gait characteristics, emphasizing the need for complementary and individualized interventions.