Levodopa Is a Double-Edged Sword for Balance and Gait in People With Parkinson's Disease

Carolin Curtze, John G. Nutt, Patricia Carlson-Kuhta, Martina Mancini, Fay B. Horak

Research output: Contribution to journalArticlepeer-review

223 Scopus citations


Background: The effects of levodopa on balance and gait function in people with Parkinson's disease (PD) is controversial. This study compared the relative responsiveness to l-dopa on six domains of balance and gait: postural sway in stance; gait pace; dynamic stability; gait initiation; arm swing; and turning in people with mild and severe PD, with and without dyskinesia. Methods: We studied 104 subjects with idiopathic PD (H & Y II [n=52] and III-IV [n=52]) and 64 age-matched controls. Subjects performed a mobility task in the practical off state and on l-dopa: standing quietly for 30 seconds, initiating gait, walking 7 meters, and turning 180 degrees. Thirty-four measures of mobility were computed from inertial sensors. Standardized response means were used to determine relative responsiveness to l-dopa. Results: The largest improvements with l-dopa were found for arm swing and pace-related gait measures. Gait dynamic stability was unaffected by PD and not responsive to l-dopa. l-dopa reduced turning duration, but only in subjects with severe PD. In contrast to gait, postural sway in quiet standing increased with l-dopa, especially in the more severely affected subjects. The increase in postural sway, as well as decrease in turning duration and exaggerated arm swing with l-dopa was observed only for subjects with dyskinesia at the time of testing. Conclusions: The observed spectrum of l-dopa responsiveness in balance and gait measures suggests that multiple neural circuits control balance and gait. Many of the negative effects of l-dopa may be directly or indirectly caused by dyskinesia.

Original languageEnglish (US)
Pages (from-to)1361-1370
Number of pages10
JournalMovement Disorders
Issue number10
StatePublished - Sep 1 2015


  • Balance
  • Gait
  • Inertial sensors
  • Levodopa
  • Parkinson's disease

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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