Levodopa Reduces Muscle Tone and Lower Extremity Tremor in Parkinson's Disease

We have quantified the effects of levodopa treatment in Parkinsonian subjects during maintained stance. Electromyographic muscle activity during quiet stance was assessed in subjects with Parkinson's disease, who exhibited a fluctuating response to levodopa, and in age-matched control subjects. Stance stability was also assessed from mean displacement and velocity of the center of pressure excursions during stance. Lower extremity and trunk muscles showed high amplitude activity in all Parkinson's subjects when “off”, and a 4–5 Hz tremor in three of these subjects. When “on”, the amplitude of muscle activity was reduced in the distal muscles more than the proximal, while tremor was suppressed in all muscles. Corresponding to the excessive muscle activity, the Parkinson's subjects had increased velocity and variability of velocity in the anterior-posterior center of foot pressure excursions, but the mean displacement of the center of pressure excursion was not different from the controls. The velocity of center of pressure excursions in the Parkinson's subjects “on”, approached those of the control subjects suggesting that the excessive distal muscle amplitude and tremor contributed to the high velocity of the center of pressure. These findings suggest that dopaminergic systems are involved in the regulation of muscle tone during stance. Depletion of dopaminergic transmission results in increased muscle tone and tremor in the lower extremities which may contribute to changes in posture and stability.