Mood fluctuations in Parkinson’s disease: a pilot study comparing the effects of intravenous and oral levodopa administration

Irene Hegeman Richard¹, Samuel Frank¹, Kori A LaDonna¹, Hongkun Wang², Michael P McDermott², Roger Kurlan¹

¹Departments of Neurology and ²Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

Objectives: Parkinson’s disease (PD) is associated with motor fluctuations that have been shown to improve when stable plasma levodopa levels are achieved with continuous levodopa infusions. Many patients also develop mood fluctuations. In this pilot study, we gathered preliminary information about the relationship between changing mood states and plasma levodopa levels.

Methods: Six patients with idiopathic PD and histories of motor and mood fluctuations participated in a double-blind levodopa infusion study. Subjects received active oral carbidopa/levodopa and a placebo levodopa infusion on one day and placebo oral carbidopa/levodopa and an active levodopa infusion on the other day, in a randomly determined order. Evaluations included serial plasma levodopa levels and assessments of mood and motor states.

Results: Only 4 of the 6 subjects demonstrated mood fluctuations on at least one of the treatment days. All subjects achieved more stable plasma levodopa levels on the active infusion day. Two subjects experienced fewer mood fluctuations on the active infusion day and two experienced fewer on the oral day.

Conclusions: The results of this pilot study suggest that the relationship between mood state and plasma levodopa level may vary among PD patients.

Keywords: Parkinson’s disease, mood, fluctuations, levodopa