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Usually, the patients with motor fluctuations initially experience progressively shorter response to each dose of levodopa (end-of dose wearing-off), and subsequently show abrupt unpredictable shifts between “on” and “off” states which are not related to drug administration (“on-off” phenomenon Adler, 2002). However, with prolonged treatment, the patients are likely to show a reduced response to levodopa, and develop motor complications including motor fluctuations and dyskinesia ( Jankovic and Stacy, 2007 Kalia and Lang, 2015). At present, levodopa (LD) is the most effective treatment for PD patients, and is commonly regarded as the “gold standard” of PD therapy ( Connolly and Lang, 2014 LeWitt, 2015). Motor symptoms of the disease include bradykinesia, muscular rigidity, rest tremor, as well as postural, and gait impairment ( Kalia and Lang, 2015). Parkinson's disease (PD) is the second common neurodegenerative disease characterized by motor and non-motor symptoms ( Kalia and Lang, 2015 Ascherio and Schwarzschild, 2016). Together, protein-restricted diets are an effective approach to improve motor fluctuations in PD patients, while long-term adherence to these diets requires monitoring for side effects. However, it should be noted that protein-restricted diets may also contribute to several side effects, including dyskinesia, weight loss, and malnutrition (e.g., protein and calcium insufficiency). On the other hand, the protein-restricted diets including low-protein diet (LPD), protein-redistribution diet (PRD) and PRD with use of low-protein products can all improve the efficacy of levodopa in patients with motor fluctuations.
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Protein-rich diets and elevated plasma concentrations of large neutral amino acids have been proved to impair the therapeutic effect of levodopa by reducing its absorption and influx into the brain.
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As the disease progresses, however, the patients are likely to experience a reduced response to levodopa and develop motor fluctuations (i.e., end-of-dose wearing off and unpredictable “on-off”). Levodopa is considered to be the most effective symptomatic drug for Parkinson's disease (PD). 2Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China.1Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Luxi Wang 1 †, Nian Xiong 1 †, Jinsha Huang 1, Shiyi Guo 1, Ling Liu 1, Chao Han 1, Guoxin Zhang 1, Haiyang Jiang 1, Kai Ma 1, Yun Xia 1, Xiaoyun Xu 1, Jie Li 1, Jing Y.