Predicting beneficial response to a protein-redistribution diet in fluctuating Parkinson's disease
Giménez-Roldán, S.; Mateo, D.
Acta Neurologica Belgica 91(4): 189-200
1991
ISSN/ISBN: 0300-9009 PMID: 1746241 Document Number: 383307
To identify factors that might help in predicting the benefit to be gained from a protein-redistribution diet (PRD), 26 patients with Parkinson's disease and motor fluctuations refractory to optimal timing and dosage of levodopa plus bromocriptine were given a daily dietary intake of 2000-2500 kcal, containing 65-80 g protein, of which 12 to 15 g could be taken during the day and unrestricted amounts could be taken 1 to 3 h before bedtime for 8-12 weeks. 15 patients were eligible for evaluation, 10 of being benefited from the PRD (79% reduction in the mean "off" time (periods of no disability) in self-scored "on-off charts). When the duration and pattern of the fluctuations were compared in the 10 diet-benefit patients with those in 5 diet-failure patients, only dose-failures consistently occurring postprandially were resolved by the PRD. Wearing-off failures responded unpredictably, while random "on-off" fluctuations were present only in the diet-failure group. Nocturnal akinesia and peak-dose dyskinesias often worsened. In no patient was "on"-time quality modified by the diet. In addition, the diet-failure group was characterized by a younger mean age at onset (P<0.05) and by longer duration in their fluctuations (P<0.001). Though requiring confirmation on a larger series, the results suggest that parkinsonian patients showing fluctuations over prolonged periods, particularly those having a pattern of random "on-off" oscillations in motor performance and dose-failures unrelated to meals, are likely to benefit from a PRD.