Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review

Lin, Zhong‐Zhe; Zhang, Chencheng; Li, Dianyou; Sun, Bomin

doi:10.1002/mdc3.13379

Cited by 19 publications

(13 citation statements)

References 105 publications

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“…On balance, this cohort appeared representative of the average population of PD patients presenting with tremor, with patient characteristics 23,24 and treatment outcomes being comparable to other studies 16,25,26 . Although levodopa responsiveness was strongly correlated with STN‐DBS response overall, the lack of levodopa responsiveness in predicting STN‐DBS outcomes for the specific motor sub‐items was interesting; this observation has previously been reported by a number of other studies 6,7,26–29 . The possibility that STN‐DBS has additional effects on brain networks, rather than just mimicking the effect of dopamine, could potentially explain this discrepancy, especially for tremor 30 .…”

Section: Discussionsupporting

confidence: 69%

“…The extent of preoperative levodopa responsiveness has traditionally been used to predict outcomes of STN‐DBS. Although this approach may have some merit particularly in predicting DBS effects on gait, akinesia, and rigidity, large discrepancies have been noted for tremor response 5,6 . Additionally, the contribution of other clinical factors, such as age, gender, or tremor characteristics in predicting responses to levodopa, STN‐DBS outcomes and the interplay of these aspects remains poorly understood and warrants further investigation 7 .…”

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confidence: 99%

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Parkinson's Disease Tremor Differentially Responds to Levodopa and Subthalamic Stimulation

Wirth,

Ferreira,

Vijiaratnam

et al. 2023

Movement Disord Clin Pract

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BackgroundTremor in Parkinson's disease (PD) has an inconsistent response to levodopa and subthalamic deep brain stimulation (STN‐DBS).ObjectivesTo identify predictive factors of PD tremor responsiveness to levodopa and STN‐DBS.Material and MethodsPD patients with upper limb tremor who underwent STN‐DBS were included. The levodopa responsiveness of tremor (overall, postural and rest sub‐components), was assessed using the relevant UPDRS‐III items performed during the pre‐operative assessment. Post‐surgical outcomes were similarly assessed on and off stimulation. A score for the Rest/Postural tremor ratio was used to determine the influence of rest and postural tremor severity on STN‐DBS outcome. Factors predictive of tremor responsiveness were determined using multiple linear regression modelling. Volume of tissue activated measurement coupled to voxel‐based analysis was performed to identify anatomical clusters associated with motor symptoms improvement.Results165 patients were included in this study. Male gender was negatively correlated with tremor responsiveness to levodopa whereas the ratio of Rest/Postural tremor was positively correlated with both Levodopa responsiveness and STN‐DBS tremor outcome. Clusters corresponding to improvement of tremor were in the subthalamic nucleus, the Zona Incerta and the thalamus while clusters corresponding to improvement for akinesia and rigidity were located within the subthalamic nucleus.ConclusionMore severe postural tremor and less severe rest tremor were associated with both poorer levodopa and STN‐DBS response. The different locations of clusters associated with best correction of tremor and other parkinsonian features suggest that STN‐DBS effect on PD symptoms is underpinned by the modulation of different networks.This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 69%

mentioning

confidence: 99%

Parkinson's Disease Tremor Differentially Responds to Levodopa and Subthalamic Stimulation

Wirth,

Ferreira,

Vijiaratnam

et al. 2023

Movement Disord Clin Pract

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“…to determine DBS candidacy (Lin et al, 2022). Other predictive factors of short-term motor response include TD phenotype, high off-medication UPDRS motor scores, young age at surgery, disease duration and baseline frontal lobe score.…”

Section: Introductionmentioning

confidence: 99%

“…Factors related to DBS outcomes are important for clinicians to predict the therapeutic effects in PD patients. Being considered as the best short-term postoperative motor response predictor, preoperative levodopa responsiveness has been routinely used to determine DBS candidacy ( Lin et al, 2022 ). Other predictive factors of short-term motor response include TD phenotype, high off-medication UPDRS motor scores, young age at surgery, disease duration and baseline frontal lobe score.…”

Section: Introductionmentioning

confidence: 99%

Bilateral globus pallidus interna deep brain stimulation in Parkinson’s disease: Therapeutic effects and motor outcomes prediction in a short-term follow up

Shen

Cao²,

Ling³

et al. 2023

Front. Hum. Neurosci.

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ObjectiveWe aimed to compare the motor effect of bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) on motor subtypes of Parkinson’s disease (PD) patients and identify preoperative predictive factors of short-term motor outcome.MethodsWe retrospectively investigated bilateral GPi DBS clinical outcomes in 55 PD patients in 1 year follow up. Motor outcome was measured by the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III before and 1 year after surgery. Clinical outcomes were compared among different motor subtypes. Preoperative predictors of motor outcome were assessed by performing univariate and multivariate linear regression and logistic regression analyses.ResultsAt 1 year following implantation, GPi DBS significantly improved the off-medication MDS-UPDRS III scores in all motor subtype cohorts, with prominent improvement in tremor. No significant difference of postoperative motor symptoms changes was found except greater tremor improvement achieved in both the tremor-dominant (TD) and indeterminate (IND) patients compared to the postural instability and gait difficulty (PIGD) patients. High percentage of PIGD patients were weak responders to DBS. Better levodopa responsiveness and more severe tremor predicted greater overall improvement of motor function in the entire cohort. Similarly, both levodopa responsiveness and tremor improvement were confirmed as predictors for motor improvement in PIGD patients.ConclusionBilateral GPi DBS could effectively improve motor outcomes in PD patients regardless of motor subtypes. Both TD and IND patients obtained larger tremor improvement. The intensity of levodopa responsiveness and the severity of tremor could serve as predictors of motor improvement 1 year after GPi DBS.

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“…significant correlation between preoperative UPDRS III reduction during the Levodopa challenge and the postoperative UPDRS III reduction in med-off stim on, 2 later confirmed in several meta-analyzes and studies for both, STN-and GPi-DBS. [3][4][5] Based on these findings, it is commonly accepted that UPDRS III reduction during Levodopa challenge may predict the STN-DBS outcome within a short follow-up period. This correlation of absolute data was reproduced by many groups but also relative levodopa responsiveness was found to relate to the STN-DBS outcome.…”

mentioning

confidence: 97%

The Role of Levodopa Challenge in Predicting the Outcome of Subthalamic Deep Brain Stimulation

Wolke

Becktepe

Paschen

et al. 2023

Movement Disord Clin Pract

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BackgroundDeep brain stimulation of the subthalamic nucleus (STN‐DBS) is an effective and evidence‐based treatment for idiopathic Parkinson's disease (iPD). A minority of patients does not sufficiently benefit from STN‐DBS.ObjectiveThe predictive validity of the levodopa challenge for individual patients is analyzed.MethodsData from patients assessed with a preoperative Levodopa‐test and a follow‐up examination (mean ± standard deviation: 9.15 months ±3.39) from Kiel (n = 253), Berlin (n = 78) and Toronto (n = 98) were studied. Insufficient DBS outcome was defined as an overall UPDRS‐III reduction <33% compared to UPDRS‐III in med‐off at baseline or alternatively if the minimal clinically important improvement of 5 points was not reached. Single UPDRS‐items and sub‐scores were dichotomized. Following exploratory analysis, we trained supervised regression‐ and classification models for outcome prediction.ResultsData analysis confirmed significant correlation between the absolute UPDRS‐III reduction during Levodopa challenge and after stimulation. But individual improvement was inaccurately predicted with a large range of up to 30 UPDRS III points. Further analysis identified preoperative UPDRS‐III/med‐off‐scores and preoperative Levodopa‐improvement as most influential factors. The models for UPDRS‐III and sub‐scores improvement achieved comparably low accuracy.ConclusionsWith large prediction intervals, the Levodopa challenge use for patient counseling is limited, though remains important for excluding non‐responders to Levodopa. Despite these deficiencies, the current practice of patient selection is highly successful and builds not only on the Levodopa challenge. However, more specific motor tasks and further paraclinical tools for prediction need to be developed.

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Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review

Cited by 19 publications

References 105 publications

Parkinson's Disease Tremor Differentially Responds to Levodopa and Subthalamic Stimulation

Parkinson's Disease Tremor Differentially Responds to Levodopa and Subthalamic Stimulation

Bilateral globus pallidus interna deep brain stimulation in Parkinson’s disease: Therapeutic effects and motor outcomes prediction in a short-term follow up

The Role of Levodopa Challenge in Predicting the Outcome of Subthalamic Deep Brain Stimulation

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