# The Effect of L-dopa on Postural Stability in Parkinson's Disease Patients
## 4 Discussion  
Postural disorders are a fundamental problem in [PERSON]'s disease. They may be an expression of the disease but can also be an undesirable symptom of treatment. This has even been reflected in the diagnostic criteria of the disease. The specific response to drugs and the occurrence of fluctuations and dyskinesia associated with their use are considered typical [PERSON]'s disease symptoms. According to the European Federation of Neurological Societies/Movement Disorder Society--European Section (EFNS/MSD-ES), L-dopa is the most effective symptomatic drug in Parkinsonism treatment (strength of Recommendation: A) [19]. However, the occurrence of motor and postural complications (on average, in about 50% of patients after 3-5 years of treatment with this drug) hinder the functioning of a patient [20]. Posture- and motor-related disorders are accompanied by fluctuations in symptoms beyond motor sensory, autonomic and neuropsychiatric symptoms [21; 22; 23]. At the stage of advanced [PERSON]'s disease (PD), gait freezing is common but nonetheless, disabling. The relationship with dopaminergic medication may often be perceived as complex and often, even non-linear. That is why freezing may even occur when core Parkinsonian features (tremor, rigidity and/or bradykinesia) may seem to optimally be under control. We conducted evaluation of the effect of Levodopa-carbidopa intrajeunal gel among a group of 7, non-demented patients with PD. They were characterized by prominent freezing episodes refractory to oral therapy adjustments. Clinical assessment was performed during the best _on_ state prior to the application of Levodopa-carbidopa intrajeunal gel, while patients were subjected to standard oral Levodopa (O-LD) and treatment using infusion. The main outcome measures regarded changes in the Freezing of Gait (FOG) Questionnaire and UPDRS motor scores. In 4 of the seven studied 7 case, the Levodopa-carbidopa intrajeunal gel dose was either equivalent or slightly higher, but for 3 patients, its level was lower in comparison to the O-LD dose noted at baseline. In the case of selected patients, Levodopa-carbidopa intrajeunal gel, compared to oral dopaminergic therapy, may improve freezing refractory [24]. The results of other studies suggest that static sway was noted as greater in IPD patients during the _off_ state compared to subjects from the control group. Furthermore, it increased by L-dopa while it was reduced by GPI-DBS. During the dynamic task, L-dopa had greater impact than GPI-DBS when improving Start Time, but reduced spatial accuracy and task-related directional control. Combining the two therapies, it was noted that GPI-DBS prevented the increase in static sway induced by L-dopa while improving dynamic task accuracy. These findings show that GPI-DBS and L-dopa have different effects when considering the temporal and spatial aspects related to postural control in IPD. Furthermore, they demonstrate that GPI-DBS may counteract some adverse effects of L-dopa. Further studies among a larger population with GPI stimulators are needed in order to confirm the findings and to clarify the actual contribution of dyskinesia in impaired dynamic postural control [25]. The aim of a different study was to characterize control of postural stability control and the responsiveness of levodopa at the early stage of Parkinson's disease (PD). Postural sway was examined during quiet stance among 10 patients within 6 years of the onset of PD. This was done both before (OFF) and after (ON) the regular dosing of oral levodopa. Postural sway was registered with the use of a force platform during a 30 sec period, the patient keeping his/her eyes open, while3 dependent variables were assessed. Mild subclinical postural sway changes were noted at baseline for our patients. 5 out of 6 characteristics (mean postural sway, transversal sway, sagittal plane sway, intensity of sway and sway area) during the _on_ condition showed it to be clearly beneficial.