LSVT-BIG Improves UPDRS III Scores at 4 Weeks in Parkinson’s Disease Patients with Wearing Off: A Prospective, Open-Label Study

Abstract

The efficacy of LSVT-BIG for advanced Parkinson’s disease (PD) patients with wearing off remains to be determined. Therefore, we evaluated whether LSVT-BIG improves motor disability in eight PD patients with wearing off. Unified Parkinson’s Disease Rating Scale (UPDRS) scores, daily off time, and mobility assessments were evaluated during the “on” time before and after the LSVT-BIG course. LSVT-BIG significantly improved UPDRS III scores at 4 weeks and UPDRS II scores in the “off” state at 12 weeks, with no changes in the other measures. The findings suggest that LSVT-BIG may be an effective therapy for advanced PD patients with wearing off.

Introduction

Wearing off is a gradual decrease in the duration of effect of each dose of medication for Parkinson’s disease (PD) [], which leads to a reduced quality of life in patients with PD []. Dopamine replacement therapy alone cannot satisfactorily treat patients with advanced PD with motor fluctuations, such as those resulting from wearing off []. Deep brain stimulation is considered for severe wearing off and troublesome dyskinesia; however, it has been reported that axial symptoms affecting speech, gait, and postural instability progressively worsened 5 years after surgery []. Therefore, an alternative procedure, such as exercise, is needed for the treatment of advanced PD with wearing off.

Exercise is an established adjunctive therapy in PD. Lee Silverman Voice Treatment- (LSVT-) BIG is an exercise course that focuses on intensive high-amplitude movements to restore normal movement amplitude by recalibrating the patient’s perception of movement [] and improves motor performance measured by the Unified Parkinson’s Disease Rating Scale (UPDRS) III in patients with PD []. However, previous studies demonstrating the efficacy of LSVT-BIG did not address the effect on “off” time []. Therefore, the efficacy of LSVT-BIG for PD patients with wearing off remains to be determined. To our knowledge, this is the first study to evaluate whether LSVT-BIG improves motor disability and reduces daily off time in PD patients presenting with wearing off motor fluctuations. We hypothesized that LSVT-BIG treatment would improve UPDRS II and III scores, reduce daily off time, and improve performance on the 10-meter walk test and Time Up and Go (TUG) test.