Dyskinesia risk calculator

Disclaimer

This risk calculator is intended for estimating the likelihood of developing dyskinesia in patients who are initiating their levodopa treatment. The calculator is based on the STRIDE-PD study and therefore the risk is calculated for the next approximately 3 years following the start of levodopa. Dyskinesia risk cannot be calculated for patients, whose characteristics (age, weight or UPDRS II score) are outside those seen in STRIDE-PD population.

This calculator is not to be used as the only tool to decide how to treat patients with levodopa and it should not replace clinical judgment on any treatment decisions.

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Calculate More Info UPDRS II scoring

Probability of dyskinesia within 169 weeks

Genderxx
Agexx
Weightxx
UPDRS IIxx
For daily levodopa doses covered by the pink bars, the risk of developing dyskinesia is ≥ 70%, but the risk cannot be estimated based on STRIDE-PD study, because this patient’s profile didn’t exist or was very rare in the database.
For daily levodopa doses covered by the pink bars, the risk of developing dyskinesia is ≤ 20%, but the risk cannot be estimated based on STRIDE-PD study, because this patient’s profile didn’t exist or was very rare in this database.
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Daily dose of levodopa (mg)

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Levodopa is the most effective agent for the symptomatic treatment of Parkinson’s disease (PD). However, long-term use of levodopa is associated with the development of motor complications such as wearing-off and dyskinesia.

This dyskinesia risk calculator is intended for estimating the probability of developing dyskinesia in PD patients who are initiating their levodopa treatment. The calculator is based on the STRIDE-PD ¹ study and therefore the risk is calculated for the next 169 weeks (approximately 3 years) following the initiation of levodopa treatment. Dyskinesia risk cannot be estimated for patients, whose characteristics (age, weight or UPDRS II score) are outside those seen in STRIDE-PD population.

In order to use the risk calculator, first select the gender of the patient and then input patient’s age, weight in kg and UDPRS part II score before the initiation of levodopa treatment using the sliders. When the Calculate button is clicked, a graph is created indicating the probability of developing dyskinesia within 169 weeks at different daily levodopa dose levels.

This calculator is intended for use by healthcare professionals. However, it is not to be used as the only tool to decide how to treat patients with levodopa and it should not replace clinical judgment on any treatment decisions. The calculator can also be used for example for educational purposes.

The risk cannot be estimated for doses lower than 150 mg or higher than 800 mg because this kind of combination of dose and predictive factors was not present in the STRIDE-PD study.

How It Works

The probability of developing dyskinesia is calculated based on risk factors identified from the STRIDE-PD study ¹. The model was developed using both statistical and clinical considerations. An initial model was created by screening the potential predictive factors for development of dyskinesia from the STRIDE-PD data using a Cox proportional hazard model. The factors to be used in the model were selected on the basis that they were statistically significant predictive factors, easy to assess in routine clinical practice and did not directly correlate with another variable being used in the model. The discriminative properties of the set of the predictive factors were assessed using the Concordance-Index (C-Index). In addition to the criteria listed above, the selected model was not to decrease the C-Index value significantly compared with the initial model.

The following factors were selected for the model estimating the risk of dyskinesia at 169 weeks − age, weight, UPDRS part II score and gender ².

Functionality of this tool has been tested with the following minimum browser versions: Internet Explorer 8, Firefox 10, Chrome 15 or Safari 5

¹ Stocchi F, Rascol O, Kieburtz K, Poewe W, Jankovic J, Tolosa E, Barone P, Lang AE, Olanow CW. Initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease: the STRIDE-PD study. Ann Neurol 2010;68(1):18–27

² Schapira AH, Poewe W, Kieburtz K, Rascol O, Stocchi F, Nissinen H, Leinonen M, Olanow CW for the STRIDE-PD Investigators. Development of a risk calculator for prediction of dyskinesia for patients with Parkinson’s disease based on the STRIDE-PD study. Mov Disord 2012; 27 (Suppl S1): 429.

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UPDRS part II (Activities of Daily Living) scoring

Please, assess the scores based on the patient’s functioning during the past one week.

5. Speech

  1. Normal.
  2. Mildly affected. No difficulty being understood.
  3. Moderately affected. Sometimes asked to repeat statements.
  4. Severely affected. Frequently asked to repeat statements.
  5. Unintelligible most of the time.

6. Salivation

  1. Normal.
  2. Slight but definite excess of saliva in mouth; may have nighttime drooling.
  3. Moderately excessive saliva; may have minimal drooling.
  4. Marked excess of saliva with some drooling.
  5. Marked drooling, requires constant tissue or handkerchief.

7. Swallowing

  1. Normal.
  2. Rare choking.
  3. Occasional choking.
  4. Requires soft food.
  5. Requires NG tube or gastrotomy feeding.

8. Handwriting

  1. Normal.
  2. Slightly slow or small.
  3. Moderately slow or small; all words are legible.
  4. Severely affected; not all words are legible.
  5. The majority of words are not legible.

9. Cutting food and handling utensils

  1. Normal.
  2. Somewhat slow and clumsy, but no help needed.
  3. Can cut most foods, although clumsy and slow; some help needed.
  4. Food must be cut by someone, but can still feed slowly.
  5. Needs to be fed.

10. Dressing

  1. Normal.
  2. Somewhat slow, but no help needed.
  3. Occasional assistance with buttoning, getting arms in sleeves.
  4. Considerable help required, but can do some things alone.
  5. Helpless.

11. Hygiene

  1. Normal.
  2. Somewhat slow, but no help needed.
  3. Needs help to shower or bathe; or very slow in hygienic care.
  4. Requires assistance for washing, brushing teeth, combing hair, going to bathroom.
  5. Foley catheter or other mechanical aids.

12. Turning in bed and adjusting bed clothes

  1. Normal.
  2. Somewhat slow and clumsy, but no help needed.
  3. Can turn alone or adjust sheets, but with great difficulty.
  4. Can initiate, but not turn or adjust sheets alone.
  5. Helpless.

13. Falling (unrelated to freezing)

  1. None.
  2. Rare falling.
  3. Occasionally falls, less than once per day.
  4. Falls an average of once daily.
  5. Falls more than once daily.

14. Freezing when walking

  1. None.
  2. Rare freezing when walking; may have starthesitation.
  3. Occasional freezing when walking.
  4. Frequent freezing. Occasionally falls from freezing.
  5. Frequent falls from freezing.

15. Walking

  1. Normal.
  2. Mild difficulty. May not swing arms or may tend to drag leg.
  3. Moderate difficulty, but requires little or no assistance.
  4. Severe disturbance of walking, requiring assistance.
  5. Cannot walk at all, even with assistance.

16. Tremor (Symptomatic complaint of tremor in any part of body.)

  1. Absent.
  2. Slight and infrequently present.
  3. Moderate; bothersome to patient.
  4. Severe; interferes with many activities.
  5. Marked; interferes with most activities.

17. Sensory complaints related to parkinsonism

  1. None.
  2. Occasionally has numbness, tingling, or mild aching.
  3. Frequently has numbness, tingling, or aching; not distressing.
  4. Frequent painful sensations.
  5. Excruciating pain.

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