| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 3075928 | Neurología | 2014 | 8 Pages |
ResumenIntroducciónLa enfermedad de Parkinson (EP) cuenta con un tratamiento sintomático amplio. No existe información fidedigna sobre los factores que influyen en la elección del tratamiento.ObjetivoIdentificar los factores que determinan el inicio del tratamiento con levodopa/carbidopa/entacapona (LCE) en pacientes con EP.Pacientes y métodosEstudio observacional, transversal retrospectivo y multicéntrico en pacientes con EP idiopática en tratamiento con LCE. Se recogieron datos sobre factores potencialmente implicados, como determinantes del inicio del tratamiento con LCE en la práctica clínica habitual.ResultadosSe estudió a 1.050 pacientes (edad media 71,3 ± 8,7 años; 58,2%, hombres), con 13,8 ± 12,9 meses de evolución hasta el diagnóstico y 74,5 ± 53,6 meses hasta el momento del inicio del tratamiento con LCE. Los síntomas iniciales incluyeron: temblor (70,6%), reducción de destreza (43,2%) y lentitud de movimientos (41,5%). El estadio de Hoehn y Yahr mayoritario al inicio de LCE fue 2 (57,5%), mientras que la escala de Schwab y England presentó una puntuación media de 73,4%. Ochocientos veintidós pacientes (78,3%) recibieron otros fármacos antes de LCE (tiempo medio entre inicio de tratamiento e inicio con LCE: 40,5 ± 47,2 meses). Los factores clínicos determinantes para iniciar el tratamiento con LCE fueron la presencia de bradicinesia (84,7%), rigidez diurna (72,2%), empeoramiento general (72,2%), dificultad marcha (66,4%), temblor (62,7%), rigidez nocturna (56,1%) e inestabilidad postural (53%). El único factor psicosocial determinante identificado fue la dificultad para realizar las actividades habituales de la vida diaria (84,3%).ConclusionesEn la EP, el inicio del tratamiento con LCE viene determinado fundamentalmente por los déficits motores y la discapacidad asociada.
IntroductionSeveral therapeutic options are available for the symptomatic treatment of Parkinson's disease (PD).There is no reliable information about which factors are involved in the choice of treatment.ObjectiveTo identify factors contributing to the decision to start treatment with levodopa/carbidopa/entacapone (LCE) in patients with PD.Patients and methodsWe completed a descriptive cross-sectional retrospective multicentre study of patients with idiopathic PD receiving LCE. Clinical data were collected with special attention to factors that could potentially determine when to initiate treatment with LCE in normal clinical practice.ResultsWe studied 1050 patients with a mean age of 71.3 ± 8.7 years (58.2% men). Average time from onset of symptoms to diagnosis was 13.8 ± 12.9 months, with a latency time of 74.5 ± 53.6 months before starting LCE treatment. The most common initial symptoms were tremor (70.6%), reduced dexterity (43.2%) and slowness of movement (41.5%). At the start of LCE treatment, most patients were in Hoehn and Yahr stage 2 (57.5%), with an average rating of 73.4% on the Schwab & England scale. Eight hundred twenty two patients (78.3%) received treatment with other drugs before starting LCE (mean time between starting any PD treatment and starting LCE was 40.5 ± 47.2 months). Clinical factors with a moderate, marked, or crucial effect on the decision to start LCE treatment were bradykinesia (84.7%), daytime rigidity (72.2%), general decline (72.2%), difficulty walking (66.4%), tremor (62.7%), nocturnal rigidity (56.1%), and postural instability (53%). Difficulty performing activities of daily living was the only psychosocial factor identified as having an influence on the decision (84.3%).ConclusionsThe decision to start patients with idiopathic PD on LCE treatment is mainly determined by motor deficits and disabilities associated with disease progression.
