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

Mov Disord. 2015 Sep;30(10):1361-70. doi: 10.1002/mds.26269. Epub 2015 Jun 12.


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.

Keywords: Parkinson's disease; balance; gait; inertial sensors; levodopa.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / pharmacology*
  • Exercise Test
  • Female
  • Gait / drug effects*
  • Gait / physiology
  • Humans
  • Levodopa / adverse effects
  • Levodopa / pharmacology*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Parkinson Disease / drug therapy*
  • Parkinson Disease / physiopathology*
  • Postural Balance / drug effects*
  • Postural Balance / physiology
  • Severity of Illness Index


  • Antiparkinson Agents
  • Levodopa