A pilot trial of dopamine replacement for dynamic facial expressions in Parkinson’s disease

Congratulations to Drs Hubert H. Fernandez, Michael S. Okun, and Dawn Bowers on the publication of “A pilot trial of dopamine replacement for dynamic facial expressions in Parkinson’s disease,” which was published in the October 20th issue of Movement Disorders Clinical Practice.



Current conflict exists regarding the potential beneficial effects of dopamine medications on facial expressivity in Parkinson disease. Via digital video analysis software, we previously found reduced facial movement (entropy) and slower time to reach peak entropy in individuals with Parkinson’s disease compared to controls.


We aimed to determine whether levodopa medications improved parameters of dynamic facial expressions (amplitude, speed).


Thirty-four individuals with idiopathic Parkinson’s disease were videotaped making voluntary facial expressions (happy, fear, anger, disgust) when “on” and “off” levodopa. Participants were 52 to 80 years old, early to mid-stage disease, non-demented, and included more men (65%). Expressions were digitized and analyzed using software that extracted three variables: two indices of movement change (total entropy, percent entropy change) and time to reach peak expression.


Indices of facial movement (total entropy, peak entropy) and timing were significantly improved when patients were “on” vs “off” medication (all F’s > 3.00, p < 0.05). For total movement and time to reach peak entropy, levodopa-related improvements were emotion nonspecific. Levodopa-related improvement for peak entropy was driven primarily by happy expressions. There was no relationship between quantitative indices and clinical measures of mood (depression, anxiety) and motor disease severity.


The effects of levodopa on Parkinson’s disease voluntary facial movement and on timing were robust and consistent with those of levodopa on other intentional movements in Parkinson’s disease. This improvement possibly occurred because of levodopa enhanced activation of face representation areas in fronto-cortical regions or because of less movement-based suppression.