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A Pilot Trial of Dopamine Replacement for Dynamic Facial Expressions in Parkinson's Disease

Authors
  • Schade, Rachel N.1
  • Springer, Utaka1, 2
  • Mikos, Ania1, 3
  • Gokcay, Didem1, 4
  • Clark, Alexandra1, 4
  • Sapienza, Christine1, 5
  • Fernandez, Hubert H.6, 7
  • Okun, Michael S.6
  • Bowers, Dawn1, 6
  • 1 University of Florida, USA , (United States)
  • 2 Native American Health Center, USA , (United States)
  • 3 Zurich, Switzerland , (Switzerland)
  • 4 University of Texas, USA , (United States)
  • 5 Jacksonville University, USA , (United States)
  • 6 University of Florida Health, USA , (United States)
  • 7 Center for Neurologic Restoration, Cleveland Clinic, USA , (United States)
Type
Published Article
Journal
Movement Disorders Clinical Practice
Publisher
John Wiley & Sons, Inc.
Publication Date
Nov 09, 2022
Volume
10
Issue
2
Pages
213–222
Identifiers
DOI: 10.1002/mdc3.13603
PMID: 36825053
PMCID: PMC9941940
Source
PubMed Central
Keywords
Disciplines
  • Research Articles
License
Unknown
External links

Abstract

Background Current conflict exists regarding the potential beneficial effects of dopamine medications on facial expressivity in Parkinson's disease. Via digital video analysis software, we previously found reduced facial movement (entropy) and slower time to reach peak entropy in individuals with Parkinson's disease compared to controls. Objectives We aimed to determine whether levodopa medications improved parameters of dynamic facial expressions (amplitude, speed). Methods A total of 34 individuals with idiopathic Parkinson's disease were videotaped making voluntary facial expressions (happy, fear, anger, disgust) when “on” and “off” levodopa. Participants were 52 to 80 years old, early to mid‐stage disease, non‐demented, and included more men (65%). Expressions were digitized and analyzed using software that extracted three variables: two indices of movement change (total entropy, percent entropy change) and time to reach peak expression. Results Indices of facial movement (total entropy, peak entropy) and timing were significantly improved when patients were “on” vs “off” medication (all F 's ≥ 3.00, P < 0.05). For total movement and time to reach peak entropy, levodopa‐related improvements were emotion nonspecific. Levodopa‐related improvement for peak entropy was driven primarily by happy expressions. There was no relationship between quantitative indices and clinical measures of mood (depression, anxiety) and motor disease severity. Conclusion The effects of levodopa on Parkinson's disease voluntary facial movement and on timing were robust and consistent with those of levodopa on other intentional movements in Parkinson's disease. This improvement possibly occurred because of levodopa enhanced activation of face representation areas in fronto‐cortical regions or because of less movement‐based suppression.

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