Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment
Background. The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson’s disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa respo...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Neural Plasticity |
| Online Access: | http://dx.doi.org/10.1155/2021/4762027 |
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| author | Zijian Zheng Zixiao Yin Bohan Zhang Houyou Fan Dan Liu Yuancheng Zhou Jian Duan Dongwei Zhou Xi Wu Guohui Lu |
| author_facet | Zijian Zheng Zixiao Yin Bohan Zhang Houyou Fan Dan Liu Yuancheng Zhou Jian Duan Dongwei Zhou Xi Wu Guohui Lu |
| author_sort | Zijian Zheng |
| collection | DOAJ |
| description | Background. The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson’s disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa response (SLR) in predicting postoperative improvement in different PD motor subtypes. Methods. Studies were split into a training set (147 patients) and a validation set (304 patients). We retrospectively collected data from 147 patients who received the Unified Parkinson’s Disease Rating Scale- (UPDRS-) III and the Parkinson’s Disease Questionnaire- (PDQ-) 39 evaluation. Patients were classified into tremor-dominant (TD), akinetic-rigid-dominant (AR), and mixed (MX) groups. Clinically important difference (CID) was employed to dichotomize DBS effects. For patients in each subtype group from the training set, we used the correlation and receiver operator characteristic (ROC) curve analyses to explore the strength of their relations. Areas under the curve (AUCs) were calculated and compared through the DeLong test. Results developed from the training set were applied into the validation set to predict postoperative improvement in different PD motor subtypes. Results. In the validation cohort, TLR significantly correlated with postoperative motor (p<0.001) and quality of life (QOL) (p<0.001) improvement in the MX group. The AUC between TLR and UPDRS-III (TU) is 0.800. The AUC between TLR and PDQ-39 (TP) is 0.770. An associated criterion in both TU and TP is around 50%. In the AR group, strong correlation was only found in SLR and PDQ-39 (SP) (p<0.001). And the AUC of SP is significantly larger than that in TLR and PDQ-39 (TP) (p=0.034). An associated criterion in SP is around 37%. No significant correlation was found in the TD group. Conclusions. We provide a more accurate judgment for LDCT. TLR strongly correlated with postoperative UPDRS-III and PDQ-39 improvement in MX patients. A TLR>50% may indicate a higher possibility of clinically meaningful benefits from STN-DBS comparing to medication only. SLR can well predict QOL improvement in AR patients. Similarly, a SLR>37% may indicate a higher possibility of clinically significant benefits from STN-DBS. LDCT provides limited information for TD patients. |
| format | Article |
| id | doaj-art-a63dca269f464df4a42a74cda71de2d7 |
| institution | Kabale University |
| issn | 2090-5904 1687-5443 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Neural Plasticity |
| spelling | doaj-art-a63dca269f464df4a42a74cda71de2d72025-02-03T05:47:08ZengWileyNeural Plasticity2090-59041687-54432021-01-01202110.1155/2021/47620274762027Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate JudgmentZijian Zheng0Zixiao Yin1Bohan Zhang2Houyou Fan3Dan Liu4Yuancheng Zhou5Jian Duan6Dongwei Zhou7Xi Wu8Guohui Lu9Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaDepartment of Neurosurgery, Changhai Hospital of the Second Military Medical University of Chinese PLA, Shanghai, ChinaDepartment of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaBackground. The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson’s disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa response (SLR) in predicting postoperative improvement in different PD motor subtypes. Methods. Studies were split into a training set (147 patients) and a validation set (304 patients). We retrospectively collected data from 147 patients who received the Unified Parkinson’s Disease Rating Scale- (UPDRS-) III and the Parkinson’s Disease Questionnaire- (PDQ-) 39 evaluation. Patients were classified into tremor-dominant (TD), akinetic-rigid-dominant (AR), and mixed (MX) groups. Clinically important difference (CID) was employed to dichotomize DBS effects. For patients in each subtype group from the training set, we used the correlation and receiver operator characteristic (ROC) curve analyses to explore the strength of their relations. Areas under the curve (AUCs) were calculated and compared through the DeLong test. Results developed from the training set were applied into the validation set to predict postoperative improvement in different PD motor subtypes. Results. In the validation cohort, TLR significantly correlated with postoperative motor (p<0.001) and quality of life (QOL) (p<0.001) improvement in the MX group. The AUC between TLR and UPDRS-III (TU) is 0.800. The AUC between TLR and PDQ-39 (TP) is 0.770. An associated criterion in both TU and TP is around 50%. In the AR group, strong correlation was only found in SLR and PDQ-39 (SP) (p<0.001). And the AUC of SP is significantly larger than that in TLR and PDQ-39 (TP) (p=0.034). An associated criterion in SP is around 37%. No significant correlation was found in the TD group. Conclusions. We provide a more accurate judgment for LDCT. TLR strongly correlated with postoperative UPDRS-III and PDQ-39 improvement in MX patients. A TLR>50% may indicate a higher possibility of clinically meaningful benefits from STN-DBS comparing to medication only. SLR can well predict QOL improvement in AR patients. Similarly, a SLR>37% may indicate a higher possibility of clinically significant benefits from STN-DBS. LDCT provides limited information for TD patients.http://dx.doi.org/10.1155/2021/4762027 |
| spellingShingle | Zijian Zheng Zixiao Yin Bohan Zhang Houyou Fan Dan Liu Yuancheng Zhou Jian Duan Dongwei Zhou Xi Wu Guohui Lu Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment Neural Plasticity |
| title | Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment |
| title_full | Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment |
| title_fullStr | Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment |
| title_full_unstemmed | Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment |
| title_short | Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment |
| title_sort | levodopa challenge test predicts stn dbs outcomes in various parkinson s disease motor subtypes a more accurate judgment |
| url | http://dx.doi.org/10.1155/2021/4762027 |
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