Effect of L-dopa on plasma homocysteine in PD patients.Relationship to B-vitamin status
Miller, J.W., Selhub,J., Nadeau, M.R., Thomas, C.A., Feldman, R.G., and Wolf, P.A. Neurology – 8-APR-2003; 60(7): 1125-9.
Objectives: l-dopa is used in the treatment of Parkinson’s disease (PD) and is known to increase both the cellular synthesis and plasma levels of homocysteine. The objective of this study was to determine the effect of supplementation with folate, and Vitamins B12 and B6 on plasma concentrations of homocyteine in l-dopa treated and control PD patients.
Methods: 40 patients were enrolled in this study on an out-patient basis. Both men and women diagnosed with idiopathic PD who showed at least two of the three cardinal criteria were included. The cardinal criteria were rigidity, resting tremor and bradykinesia. Specific exclusion criteria included pregnancy, dietary restrictions, and a history of neurodegenerative disorders other than PD, drug or alcohol abuse, depression or other major medical disorders also correlated with a Vitamin B deficiency status. 20 of the patients were concurrently treated with the standard l-dopa/carbidopa combination (treatment group) and 20 were l-dopa-naïve (control group). Levels of plasma homocysteine, folate, Vitamins B12 and B6 were measured and correlated with the treatment and control groups.
Results: Higher plasma levels of homocysteine and lower plasma levels of the vitamin were found with the l-dopa/carbidopa group. In the control group, similar plasma levels of B vitamins were not associated with higher levels of homocysteine. (P<.001)
Conclusions: PD patients treated with l-dopa should be monitored for their homocysteine levels as these can increase with treatment. The extent of the plasma hyperhomocysteinemia is inversely related to B-vitamin status. Supplementation of PD patients on l-dopa with B-vitamins should be considered.
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