Prevalence of Levodopa-Induced Peripheral Neuropathy in Patients with Parkinson’s Disease and Vitamin B12 Deficiency
AbstractBackground: Parkinson’s disease (PD) is one of the widespread neurodegenerative diseases. Recently, a few studies have suggested that treatment with levodopa and vitamin B12 deficiency may have some role in developing peripheral neuropathy (PN) among PD patients. Hence, the aim of this study was to evaluate PN in patients suffering from PD under long-term treatment with levodopa and also vitamin B12 deficiency in these patients. Materials and Methods: Thirty PD patients who received levodopa for at least two years, 30 levodopa-naïve PD patients, and 30 age-matched controls individuals were included. The participants were subjected to electrodiagnostic tests and the level of vitamin B12 was measured. The prevalence of neuropathy was determined according to electrodiagnostic criteria and compared among the three groups. Results: Overall, 23.3% of cases in levodopa receivers, 3.3% in the levodopa-naïve group, and 3.3% in control group had PN (odds ratio=8.8, 95% confidence interval=1.7-45.6). Levodopa group had significantly lower serum vitamin B12 than the other two groups (P=0.006). Vitamin B12 insufficiency was detected in 36.6% of patients in the levodopa group, which was significantly higher than other groups (23.3% in the levodopa-naïve and 6.6% in the control groups, P=0.02). A significantly negative correlation was noticed between the duration of levodopa exposure and serum level of vitamin B12 (r=-0.31, P=0.016). Conclusion: Our study demonstrated a significantly higher prevalence of vitamin B12 insufficiency and PN in PD patients under treatment with levodopa. Also, our results advocate the role of levodopa in PN development through the vitamin B12 derangement. [GMJ.2021;10:e1837]
Poewe W, Seppi K, Tanner CM, Halliday GM, Brundin P, Volkmann J et al. Parkinson disease. Nat Rev Dis Primers. 2017;3(1):17013.
Ceravolo R, Cossu G, Bandettini di Poggio M, Santoro L, Barone P, Zibetti M et al. Neuropathy and levodopa in Parkinson's disease: evidence from a multicenter study. Mov Disord. 2013;28(10):1391-7.
Mancini F, Comi C, Oggioni GD, Pacchetti C, Calandrella D, Moja MC et al. Prevalence and features of peripheral neuropathy in Parkinson's disease patients under different therapeutic regimens. Parkinsonism Relat Disord. 2014;20(1):27-31.
Müller T, van Laar T, Cornblath DR, Odin P, Klostermann F, Grandas FJ et al. Peripheral neuropathy in Parkinson's disease: levodopa exposure and implications for duodenal delivery. Parkinsonism Relat Disord. 2013;19(5):501-7.
Toth C, Breithaupt K, Ge S, Duan Y, Terris JM, Thiessen A et al. Levodopa, methylmalonic acid, and neuropathy in idiopathic Parkinson disease. Ann Neurol. 2010;68(1):28-36.
Toth C, Brown MS, Furtado S, Suchowersky O, Zochodne D. Neuropathy as a potential complication of levodopa use in Parkinson's disease. Mov Disord. 2008;23(13):1850-9.
Zis P, Grünewald RA, Chaudhuri RK, Hadjivassiliou M. Peripheral neuropathy in idiopathic Parkinson's disease: a systematic review. J Neurol Sci. 2017;378:204-9.
Brattström L. Plasma homocysteine and MTHFR C677T genotype in levodopa-treated patients with PD. Neurology. 2001;56(2):281-2.
Lökk J. Treatment with levodopa can affect latent vitamin B 12 and folic acid deficiency. Patients with Parkinson disease runt the risk of elevated homocysteine levels. Lakartidningen. 2003;100(35):2674-7.
Rajabally YA, Martey J. Neuropathy in Parkinson disease: prevalence and determinants. Neurology. 2011;77(22):1947-50.
Müller T, Renger K, Kuhn W. Levodopa-associated increase of homocysteine levels and sural axonal neurodegeneration. Arch Neurol. 2004;61(5):657-60.
Urban PP, Wellach I, Faiss S, Layer P, Rosenkranz T, Knop K et al. Subacute axonal neuropathy in Parkinson's disease with cobalamin and vitamin B6 deficiency under duodopa therapy. Mov Disord. 2010;25(11):1748-52.
Klostermann F, Jugel C, Müller T, Marzinzik F. Malnutritional neuropathy under intestinal levodopa infusion. J Neural Transm. 2012;119(3):369-72.
Bargiotas P, Konitsiotis S. Levodopa-induced dyskinesias in Parkinson's disease: emerging treatments. Neuropsychiatr Dis Treat. 2013;9:1605.
Domkundwar S, Autkar G, Khadilkar SV, Virarkar M. Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies. J Ultrasound. 2017;20(2):111-22.
Smith EML, Beck SL, Cohen J. The total neuropathy score: a tool for measuring chemotherapy-induced peripheral neuropathy. Oncol Nurs Forum. 2008;35:96.
Wampler MA, Miaskowski C, Hamel K, Byl N, Rugo H, Topp KS. The modified total neuropathy score: a clinically feasible and valid measure of taxane-induced peripheral neuropathy in women with breast cancer. J Support Oncol. 2006;4(8):W9-W16.
Gilchrist LS, Tanner L. The pediatric-modified total neuropathy score: a reliable and valid measure of chemotherapy-induced peripheral neuropathy in children with non-CNS cancers. Support Care Cancer. 2013;21(3):847-56.
Sajdyk T, Boyle F, Foran K, Tong Y, Pandya P, Smith E et al. NTOX-12. OBESITY AS A POTENTIAL ATTRIBUTE FOR VINCRISTINE INDUCED PERIPHERAL NEUROPATHY. Neuro-oncology. 2017;19(Suppl 6):vi167.
Ghoreishi Z, Keshavarz S, Asghari Jafarabadi M, Fathifar Z, Goodman KA, Esfahani A. Risk factors for paclitaxel-induced peripheral neuropathy in patients with breast cancer. BMC Cancer. 2018;18(1):958.
Huynh W, Kiernan MC. Nerve conduction studies. Aust Fam Physician. 2011;40(9):693.
Romagnolo A, Merola A, Artusi CA, Rizzone MG, Zibetti M, Lopiano L. Levodopa-Induced Neuropathy: A Systematic Review. Mov Disord Clin Pract. 2019;6(2):96-103.
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