Abstract
Objective: To investigate the correlation between preoperative response to the L-dopa challenge test and efficacy of deep brain stimulation (DBS) on motor function in Parkinson’s disease (PD).Methods: We retrospectively reviewed the data of 38 patients with idiopathic PD who underwent DBS surgery with a median follow-up duration of 7 months. Twenty underwent bilateral globus pallidus interna (GPi) DBS, and 18 underwent bilateral subthalamic nucleus (STN) DBS. The Movement Disorder Society Unified Parkinson Disease Rating Scale-Motor Part (MDS UPDRS-III) was assessed before surgery and at the last follow-up in different medication and stimulation conditions, respectively.Results: Pearson’s correlation analysis revealed a positive correlation between preoperative L-dopa challenge responsiveness and GPi-DBS responsiveness on the total score (R2 = 0.283, p = 0.016) but not on the non-tremor total score (R2 = 0.158, p = 0.083) of MDS UPDRS-III. Such correlation remained significant (R2′ = 0.332, p = 0.010) after controlling for age at the time of surgery as confounding factor by partial correlation analysis. The preoperative L-dopa challenge responsiveness was significantly correlated with the tremor-controlling outcome of GPi-DBS (R2 = 0.390, p = 0.003). In contrast, we found a positive correlation between preoperative L-dopa challenge responsiveness and STN-DBS responsiveness on the non-tremor total score (R2 = 0.290, p = 0.021), but not on the total score (R2 = 0.130, p = 0.141) of MDS UPDRS-III. The partial correlation analysis further demonstrated that the predictive value of preoperative L-dopa challenge responsiveness on the non-tremor motor outcome of STN-DBS was eliminated (R2′ = 0.120, p = 0.174) after controlling for age at the time of surgery as confounding factor.Interpretation: The short-term predictive value of preoperative response to the L-dopa challenge test for the motor outcome of GPi-DBS in PD was systematically described. Our findings suggest: (1) a solid therapeutic effect of GPi-DBS in treating L-dopa-responsive tremors; (2) a negative effect of age at the time of surgery on motor outcomes of STN-DBS, (3) a possible preference of STN- to GPi-DBS in L-dopa-resistant tremor control, and (4) a possible preference of GPi- to STN-DBS in elderly PD patients who have a satisfactory dopamine response.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disorder characterized by striatal dopamine deficiency, resulting from a selective neuronal loss in the substantia nigra (Kalia and Lang, 2015)
We aimed to describe the value of preoperative L-dopa responsiveness following the L-dopa challenge test for predicting motor outcomes of globus pallidus interna (GPi)-Deep brain stimulation (DBS) in PD
The non-tremor total score of MDS UPDRS-III was calculated as the sum of subscores of rigidity, bradykinesia, and axial symptoms
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disorder characterized by striatal dopamine deficiency, resulting from a selective neuronal loss in the substantia nigra (Kalia and Lang, 2015). Satisfactory L-dopa responsiveness, a critical component of the diagnosis of idiopathic PD (Rizzo et al, 2016; Armstrong and Okun, 2020), has been the widely accepted criterion for DBS surgery patient selection (Pollak, 2013). Charles et al (2002) and Welter et al (2002) reported the value of preoperative L-dopa responsiveness as a predictor of STN-DBS efficacy on motor function in PD during the 3- and 6-month follow-up, respectively. Piboolnurak et al (2007) argued that the magnitude of the preoperative response to L-dopa was limited in predicting the benefits of STN-DBS at the 3- and 5-year followup. Most previous studies only enrolled patients undergoing STN-DBS, while the value of preoperative L-dopa responsiveness as a predictor for GPi-DBS responsiveness has not been adequately studied
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
