PD – Levodopa Non-Responsive Features — SCE Neurology MCQ

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ModerateMovement DisordersPD – Levodopa Non-Responsive FeaturesSCE Neurology

A 65-year-old man with Parkinson's disease has been stable on co-careldopa for 5 years. He develops progressive postural instability and recurrent falls. His neurologist reviews potential causes. Which feature in PD is least responsive to levodopa?

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Correct answer: A — Postural instability and gait disorder

Explanation lettering: D = shown as A · A = shown as C · C = shown as D

Postural instability and gait disorder (PIGD) is the motor feature of PD that responds least to levodopa. It is thought to involve non-dopaminergic pathways (cholinergic, noradrenergic, serotonergic). This is in contrast to tremor, bradykinesia, and rigidity, which respond well to dopaminergic therapy. PIGD-dominant PD has a worse prognosis than tremor-dominant PD. Non-pharmacological interventions (physiotherapy, gait training, external cueing, falls prevention strategies) are the mainstay of management for postural instability. A/B/C: These respond well to levodopa. E: Hypomimia (reduced facial expression) responds to levodopa.

Reference: NICE NG71 Parkinson's Disease (2017); Jankovic PD Motor Subtypes