Verbal communication about drug dosage balances drug reduction in Parkinson's disease: Behavioral and electrophysiological evidences

• Published in: Parkinsonism & related disorders 2019-08, Vol.65, p.184-189
• Main Authors: Carlino, Elisa, Piedimonte, Alessandro, Romagnolo, Alberto, Guerra, Giulia, Frisaldi, Elisa, Vighetti, Sergio, Lopiano, Leonardo, Benedetti, Fabrizio
• Format: Article
• Language: English
• Subjects: Fatigue; l-dopa; Motor performance; Nocebo effect; Parkinson's disease; Placebo effect; Readiness potential
• ISSN: 1353-8020; 1873-5126
• DOI: 10.1016/j.parkreldis.2019.06.015

Changing drug dosage is common in clinical practice. Recent evidence showed that psychological factors may affect the therapeutic outcome. The aim of this study is to test whether verbal communication about drug dosage changes motor performance and fatigue in Parkinson's Disease (PD) patients. We performed clinical (Unified PD Rating Scale), motor (number of finger flexions and perceived fatigue), and electrophysiological measurements (readiness potential, RP) in PD patients during medication-off and medication-on conditions in three groups. The first group got a full dose of l-dopa and was told it was a full dose. The second group got half dose and was told it was half dose. The third group got half dose, but it was told it was a full standard dose. We found that overt half dose was less effective than the full dose for clinical improvement, motor performance, and readiness potential. However, if half dose was given along with verbal instructions that it was a full dose, clinical improvement, motor performance and readiness potential were not significantly different from the full dose. Our findings indicate that verbal communication about dose reduction is as effective as the 50% dose reduction itself, demonstrating that deceptive information about the dose may have an important impact on the therapeutic outcome. Moreover, the supplementary motor area, source of the RP, seems to be involved in this psychological effect. •Verbal communication about l-dopa dosage can modulate clinical improvement and motor performance in Parkinson's Disease.•l-dopa half dose accompanied by instructions indicating that it was indeed half dose, was less effective than the full dose.•l-dopa half dose accompanied by positive instructions indicating that it was a full dose, was as effective as the full dose.