Is Levodopa Response a Valid Indicator of Parkinson's Disease?

Authors

W R. Martin, Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.
Michael Miles, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Qiaonan Zhong, Department of Medicine, Mayo Clinic, Rochester, Missouri, USA.
Johanna Hartlein, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Brad A. Racette, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Scott A. Norris, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Mwiza Ushe, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Baijayanta Maiti, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Susan Criswell, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Albert A. Davis, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Paul T. Kotzbauer, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Nigel J. Cairns, College of Medicine and Health, University of Exeter, Exeter, United Kingdom.
Richard J. Perrin, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.
Joel S. Perlmutter, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA.

Document Type

Article

Abstract

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.

Medical Subject Headings

Humans; Levodopa (therapeutic use); Multiple System Atrophy; Parkinson Disease (drug therapy); Parkinsonian Disorders; Supranuclear Palsy, Progressive

Publication Date

4-1-2021

Publication Title

Movement disorders : official journal of the Movement Disorder Society

E-ISSN

1531-8257

Volume

36

Issue

4

First Page

948

Last Page

954

PubMed ID

33253432

Digital Object Identifier (DOI)

10.1002/mds.28406

Recommended Citation

Martin, W R.; 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.; and Perlmutter, Joel S., "Is Levodopa Response a Valid Indicator of Parkinson's Disease?" (2021). Neurology. 1142.
https://scholar.barrowneuro.org/neurology/1142