Is Levodopa Response a Valid Indicator of Parkinson's Disease?
Parkinson's disease
diagnostic specificity
levodopa
parkinsonism
Journal
Movement disorders : official journal of the Movement Disorder Society
ISSN: 1531-8257
Titre abrégé: Mov Disord
Pays: United States
ID NLM: 8610688
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
07
11
2020
received:
31
07
2020
accepted:
10
11
2020
pubmed:
1
12
2020
medline:
20
5
2021
entrez:
30
11
2020
Statut:
ppublish
Résumé
The clinical diagnosis of Parkinson's disease (PD) requires the presence of parkinsonism and supportive criteria that include a clear and dramatic beneficial response to dopaminergic therapy. Our aim was to test the diagnostic criterion of dopaminergic response by evaluating its association with pathologically confirmed diagnoses in a large population of parkinsonian patients. We reviewed clinical data maintained in an electronic medical record from all patients with autopsy data who had been seen in the Movement Disorders Center at Washington University, St. Louis, between 1996 and 2018. All patients with parkinsonism who underwent postmortem neuropathologic examination were included in this analysis. There were 257 unique parkinsonian patients with autopsy-based diagnoses who had received dopaminergic therapy. Marked or moderate response to dopaminergic therapy occurred in 91.2% (166/182) of those with autopsy-confirmed PD, 52.0% (13/25) of those with autopsy-confirmed multiple systems atrophy, 44.4% (8/18) of those with autopsy-confirmed progressive supranuclear palsy, and 1 (1/8) with autopsy-confirmed corticobasal degeneration. Other diagnoses were responsible for the remaining 24 individuals, 9 of whom had a moderate response to dopaminergic therapy. A substantial response to dopaminergic therapy is frequent but not universal in PD. An absent response does not exclude PD. In other neurodegenerative disorders associated with parkinsonism, a prominent response may also be evident, but this occurs less frequently than in PD. © 2020 International Parkinson and Movement Disorder Society.
Sections du résumé
BACKGROUND
The clinical diagnosis of Parkinson's disease (PD) requires the presence of parkinsonism and supportive criteria that include a clear and dramatic beneficial response to dopaminergic therapy. Our aim was to test the diagnostic criterion of dopaminergic response by evaluating its association with pathologically confirmed diagnoses in a large population of parkinsonian patients.
METHODS
We reviewed clinical data maintained in an electronic medical record from all patients with autopsy data who had been seen in the Movement Disorders Center at Washington University, St. Louis, between 1996 and 2018. All patients with parkinsonism who underwent postmortem neuropathologic examination were included in this analysis.
RESULTS
There were 257 unique parkinsonian patients with autopsy-based diagnoses who had received dopaminergic therapy. Marked or moderate response to dopaminergic therapy occurred in 91.2% (166/182) of those with autopsy-confirmed PD, 52.0% (13/25) of those with autopsy-confirmed multiple systems atrophy, 44.4% (8/18) of those with autopsy-confirmed progressive supranuclear palsy, and 1 (1/8) with autopsy-confirmed corticobasal degeneration. Other diagnoses were responsible for the remaining 24 individuals, 9 of whom had a moderate response to dopaminergic therapy.
CONCLUSION
A substantial response to dopaminergic therapy is frequent but not universal in PD. An absent response does not exclude PD. In other neurodegenerative disorders associated with parkinsonism, a prominent response may also be evident, but this occurs less frequently than in PD. © 2020 International Parkinson and Movement Disorder Society.
Identifiants
pubmed: 33253432
doi: 10.1002/mds.28406
pmc: PMC8046721
mid: NIHMS1668332
doi:
Substances chimiques
Levodopa
46627O600J
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
948-954Subventions
Organisme : NIEHS NIH HHS
ID : R01 ES030937
Pays : United States
Organisme : NIA NIH HHS
ID : U19 AG032438
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG066444
Pays : United States
Organisme : NINDS NIH HHS
ID : R21 NS109831
Pays : United States
Organisme : NINDS NIH HHS
ID : U19 NS110456
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS109487
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS107281
Pays : United States
Organisme : NINDS NIH HHS
ID : U54 NS116025
Pays : United States
Organisme : NIA NIH HHS
ID : U01 AG024904
Pays : United States
Organisme : NINDS NIH HHS
ID : K08 NS101118
Pays : United States
Organisme : NIA NIH HHS
ID : RF1 AG053550
Pays : United States
Organisme : NIA NIH HHS
ID : RF1 AG064937
Pays : United States
Organisme : NIA NIH HHS
ID : P01 AG003991
Pays : United States
Organisme : NIA NIH HHS
ID : P50 AG005681
Pays : United States
Organisme : NIEHS NIH HHS
ID : R01 ES025991
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG050263
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS075321
Pays : United States
Organisme : NIA NIH HHS
ID : U19 AG024904
Pays : United States
Organisme : NCATS NIH HHS
ID : U54 TR001456
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS103957
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS075527
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS110436
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG054567
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS097437
Pays : United States
Organisme : NIA NIH HHS
ID : UF1 AG032438
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS097799
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002346
Pays : United States
Organisme : NIEHS NIH HHS
ID : R01 ES029524
Pays : United States
Organisme : NINDS NIH HHS
ID : U54 NS065701
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG054513
Pays : United States
Organisme : NIEHS NIH HHS
ID : R01 ES026891
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG052550
Pays : United States
Organisme : NCCIH NIH HHS
ID : R61 AT010753
Pays : United States
Organisme : NINDS NIH HHS
ID : U10 NS077384
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS092865
Pays : United States
Organisme : NIOSH CDC HHS
ID : R01 OH011661
Pays : United States
Informations de copyright
© 2020 International Parkinson and Movement Disorder Society.
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