Is levodopa response a valid indicator of Parkinson disease?

Details

• Alternative Title:
  Mov Disord
• Personal Author:
  Martin, W R Wayne ; Miles, Michael ; Zhong, Qiaonan ; Hartlein, Johanna ; Racette, Brad A ; Norris, Scott A. ; Ushe, Mwiza ; Maiti, Baijayanta ; Criswell, Susan ; Davis, Albert A ; Kotzbauer, Paul T ; Cairns, Nigel J ; Perrin, Richard J ; Perlmutter, Joel S
• Description:
  Objective/background
  
  The clinical diagnosis of Parkinson disease (PD) requires the presence of parkinsonism and supportive criteria that include a clear and dramatic beneficial response to dopaminergic therapy. Our objective 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) with autopsy-confirmed progressive supranuclear palsy, and one (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.
  
  
• Subjects:
  Article Diagnostic Specificity Humans Levodopa Multiple System Atrophy Parkinson Disease Parkinsonian Disorders Parkinsonism Supranuclear Palsy, Progressive
• Source:
  Mov Disord.
• Pubmed ID:
  33253432
• Pubmed Central ID:
  PMC8046721
• Document Type:
  Journal Article
• Funding:
  R01 ES030937/ES/NIEHS NIH HHSUnited States/ ; U19 AG032438/AG/NIA NIH HHSUnited States/ ; P30 AG066444/AG/NIA NIH HHSUnited States/ ; R21 NS109831/NS/NINDS NIH HHSUnited States/ ; U19 NS110456/NS/NINDS NIH HHSUnited States/ ; R01 NS109487/NS/NINDS NIH HHSUnited States/ ; R01 NS107281/NS/NINDS NIH HHSUnited States/ ; U54 NS116025/NS/NINDS NIH HHSUnited States/ ; U01 AG024904/AG/NIA NIH HHSUnited States/ ; K08 NS101118/NS/NINDS NIH HHSUnited States/ ; RF1 AG053550/AG/NIA NIH HHSUnited States/ ; RF1 AG064937/AG/NIA NIH HHSUnited States/ ; P01 AG003991/AG/NIA NIH HHSUnited States/ ; P50 AG005681/AG/NIA NIH HHSUnited States/ ; R01 ES025991/ES/NIEHS NIH HHSUnited States/ ; R01 AG050263/AG/NIA NIH HHSUnited States/ ; R01 NS075321/NS/NINDS NIH HHSUnited States/ ; U19 AG024904/AG/NIA NIH HHSUnited States/ ; U54 TR001456/TR/NCATS NIH HHSUnited States/ ; R01 NS103957/NS/NINDS NIH HHSUnited States/ ; R01 NS075527/NS/NINDS NIH HHSUnited States/ ; U01 NS110436/NS/NINDS NIH HHSUnited States/ ; R01 AG054567/AG/NIA NIH HHSUnited States/ ; R01 NS097437/NS/NINDS NIH HHSUnited States/ ; UF1 AG032438/AG/NIA NIH HHSUnited States/ ; R01 NS097799/NS/NINDS NIH HHSUnited States/ ; KL2 TR002346/TR/NCATS NIH HHSUnited States/ ; R01 ES029524/ES/NIEHS NIH HHSUnited States/ ; U54 NS065701/NS/NINDS NIH HHSUnited States/ ; R01 AG054513/AG/NIA NIH HHSUnited States/ ; R01 ES026891/ES/NIEHS NIH HHSUnited States/ ; R01 AG052550/AG/NIA NIH HHSUnited States/ ; R61 AT010753/AT/NCCIH NIH HHSUnited States/ ; U10 NS077384/NS/NINDS NIH HHSUnited States/ ; R01 NS092865/NS/NINDS NIH HHSUnited States/ ; R01 OH011661/OH/NIOSH CDC HHSUnited States/
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:af68007f3e7a86d1c8a9e760ac1d985c07b0310b1309a7ffd017415856ab6cb9
• Download URL:
  https://stacks.cdc.gov/view/cdc/105277/cdc_105277_DS1.pdf
• File Type:
  [PDF - 336.09 KB ]