Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis.
Identifieur interne : 003A08 ( PubMed/Curation ); précédent : 003A07; suivant : 003A09Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis.
Auteurs : Marcelo Merello [Argentine] ; Maria I. Nouzeilles ; Gabriel Piran Arce ; Ram N LeiguardaSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2002.
English descriptors
- KwdEn :
- Aged, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Levodopa (adverse effects), Levodopa (diagnostic use), Levodopa (therapeutic use), Long-Term Care, Male, Middle Aged, Neurologic Examination (drug effects), Parkinson Disease (diagnosis), Parkinson Disease (drug therapy), Predictive Value of Tests.
- MESH :
- chemical , adverse effects : Levodopa.
- chemical , diagnostic use : Levodopa.
- chemical , therapeutic use : Levodopa.
- diagnosis : Parkinson Disease.
- drug effects : Neurologic Examination.
- drug therapy : Parkinson Disease.
- Aged, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Long-Term Care, Male, Middle Aged, Predictive Value of Tests.
Abstract
Clinical idiopathic Parkinson's disease (PD) diagnosis requires following strict clinical criteria. Final definitive diagnosis can only be made after pathological confirmation and, despite following clinical criteria, several cases are misdiagnosed. We assessed sensitivity and specificity of acute challenge with levodopa (L-dopa) to predict sustained long-term L-dopa responsiveness as a major criterion for clinical diagnosis of PD. A consecutive series of 82 patients first seen at a movement disorders clinic with a parkinsonian syndrome without specific diagnosis was included. A second examiner, blind to the presumptive diagnosis, performed in each patient an acute challenge with 250/50 mg of L-dopa-carbidopa and rated the test as positive or negative according to whether values reached a minimal 30% of improvement on UPDRS scores. Positive tests were considered supportive of presumptive clinical diagnosis of Parkinson's disease. Blind to test results and according to clinical presumption, the first examiner started patient treatment with the necessary L-dopa dose or, alternatively, until reaching 1 g for 1 month in those who failed to display a positive test response. At 24 month follow-up, they were re-tested with 1 g for 1 month when required. At this point, clinical criteria of the U.K. Parkinson's Disease Society Brain Bank were applied and definitive clinical diagnosis of PD was made. Sensitivity, specificity, and positive predictive ratio for acute challenge were calculated. Overall sensitivity and specificity of acute L-dopa challenge to predict clinical diagnosis of PD was 70.9% and 81.4%, respectively; positive predictive ratio was 88.6%. When patients were divided into three groups according to their UPDRS motor section score at initial examination, sensitivity and specificity varied: Group I (or=21), 36.4% and 87%, respectively. Positive predictive ratio increased to 100% in Group I and to 87.5% in Group III. The positive result of initial acute L-dopa challenge predicts chronic L-dopa responsiveness as major criterion of PD in all patients with UPDRS motor scores lower than 10.
DOI: 10.1002/mds.10123
PubMed: 12210878
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis.</title><author><name sortKey="Merello, Marcelo" sort="Merello, Marcelo" uniqKey="Merello M" first="Marcelo" last="Merello">Marcelo Merello</name><affiliation wicri:level="1"><nlm:affiliation>Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.</nlm:affiliation><country xml:lang="fr">Argentine</country><wicri:regionArea>Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires</wicri:regionArea></affiliation></author><author><name sortKey="Nouzeilles, Maria I" sort="Nouzeilles, Maria I" uniqKey="Nouzeilles M" first="Maria I" last="Nouzeilles">Maria I. Nouzeilles</name></author><author><name sortKey="Arce, Gabriel Piran" sort="Arce, Gabriel Piran" uniqKey="Arce G" first="Gabriel Piran" last="Arce">Gabriel Piran Arce</name></author><author><name sortKey="Leiguarda, Ram N" sort="Leiguarda, Ram N" uniqKey="Leiguarda R" first="Ram N" last="Leiguarda">Ram N Leiguarda</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2002">2002</date><idno type="RBID">pubmed:12210878</idno><idno type="pmid">12210878</idno><idno type="doi">10.1002/mds.10123</idno><idno type="wicri:Area/PubMed/Corpus">003A08</idno><idno type="wicri:Area/PubMed/Curation">003A08</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis.</title><author><name sortKey="Merello, Marcelo" sort="Merello, Marcelo" uniqKey="Merello M" first="Marcelo" last="Merello">Marcelo Merello</name><affiliation wicri:level="1"><nlm:affiliation>Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.</nlm:affiliation><country xml:lang="fr">Argentine</country><wicri:regionArea>Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires</wicri:regionArea></affiliation></author><author><name sortKey="Nouzeilles, Maria I" sort="Nouzeilles, Maria I" uniqKey="Nouzeilles M" first="Maria I" last="Nouzeilles">Maria I. Nouzeilles</name></author><author><name sortKey="Arce, Gabriel Piran" sort="Arce, Gabriel Piran" uniqKey="Arce G" first="Gabriel Piran" last="Arce">Gabriel Piran Arce</name></author><author><name sortKey="Leiguarda, Ram N" sort="Leiguarda, Ram N" uniqKey="Leiguarda R" first="Ram N" last="Leiguarda">Ram N Leiguarda</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="ISSN">0885-3185</idno><imprint><date when="2002" type="published">2002</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Levodopa (adverse effects)</term><term>Levodopa (diagnostic use)</term><term>Levodopa (therapeutic use)</term><term>Long-Term Care</term><term>Male</term><term>Middle Aged</term><term>Neurologic Examination (drug effects)</term><term>Parkinson Disease (diagnosis)</term><term>Parkinson Disease (drug therapy)</term><term>Predictive Value of Tests</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Levodopa</term></keywords><keywords scheme="MESH" type="chemical" qualifier="diagnostic use" xml:lang="en"><term>Levodopa</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Neurologic Examination</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Long-Term Care</term><term>Male</term><term>Middle Aged</term><term>Predictive Value of Tests</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Clinical idiopathic Parkinson's disease (PD) diagnosis requires following strict clinical criteria. Final definitive diagnosis can only be made after pathological confirmation and, despite following clinical criteria, several cases are misdiagnosed. We assessed sensitivity and specificity of acute challenge with levodopa (L-dopa) to predict sustained long-term L-dopa responsiveness as a major criterion for clinical diagnosis of PD. A consecutive series of 82 patients first seen at a movement disorders clinic with a parkinsonian syndrome without specific diagnosis was included. A second examiner, blind to the presumptive diagnosis, performed in each patient an acute challenge with 250/50 mg of L-dopa-carbidopa and rated the test as positive or negative according to whether values reached a minimal 30% of improvement on UPDRS scores. Positive tests were considered supportive of presumptive clinical diagnosis of Parkinson's disease. Blind to test results and according to clinical presumption, the first examiner started patient treatment with the necessary L-dopa dose or, alternatively, until reaching 1 g for 1 month in those who failed to display a positive test response. At 24 month follow-up, they were re-tested with 1 g for 1 month when required. At this point, clinical criteria of the U.K. Parkinson's Disease Society Brain Bank were applied and definitive clinical diagnosis of PD was made. Sensitivity, specificity, and positive predictive ratio for acute challenge were calculated. Overall sensitivity and specificity of acute L-dopa challenge to predict clinical diagnosis of PD was 70.9% and 81.4%, respectively; positive predictive ratio was 88.6%. When patients were divided into three groups according to their UPDRS motor section score at initial examination, sensitivity and specificity varied: Group I (or=21), 36.4% and 87%, respectively. Positive predictive ratio increased to 100% in Group I and to 87.5% in Group III. The positive result of initial acute L-dopa challenge predicts chronic L-dopa responsiveness as major criterion of PD in all patients with UPDRS motor scores lower than 10.</div> </front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">12210878</PMID><DateCreated><Year>2002</Year><Month>09</Month><Day>04</Day></DateCreated><DateCompleted><Year>2002</Year><Month>11</Month><Day>20</Day></DateCompleted><DateRevised><Year>2013</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0885-3185</ISSN><JournalIssue CitedMedium="Print"><Volume>17</Volume><Issue>4</Issue><PubDate><Year>2002</Year><Month>Jul</Month></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. Disord.</ISOAbbreviation></Journal><ArticleTitle>Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis.</ArticleTitle><Pagination><MedlinePgn>795-8</MedlinePgn></Pagination><Abstract><AbstractText>Clinical idiopathic Parkinson's disease (PD) diagnosis requires following strict clinical criteria. Final definitive diagnosis can only be made after pathological confirmation and, despite following clinical criteria, several cases are misdiagnosed. We assessed sensitivity and specificity of acute challenge with levodopa (L-dopa) to predict sustained long-term L-dopa responsiveness as a major criterion for clinical diagnosis of PD. A consecutive series of 82 patients first seen at a movement disorders clinic with a parkinsonian syndrome without specific diagnosis was included. A second examiner, blind to the presumptive diagnosis, performed in each patient an acute challenge with 250/50 mg of L-dopa-carbidopa and rated the test as positive or negative according to whether values reached a minimal 30% of improvement on UPDRS scores. Positive tests were considered supportive of presumptive clinical diagnosis of Parkinson's disease. Blind to test results and according to clinical presumption, the first examiner started patient treatment with the necessary L-dopa dose or, alternatively, until reaching 1 g for 1 month in those who failed to display a positive test response. At 24 month follow-up, they were re-tested with 1 g for 1 month when required. At this point, clinical criteria of the U.K. Parkinson's Disease Society Brain Bank were applied and definitive clinical diagnosis of PD was made. Sensitivity, specificity, and positive predictive ratio for acute challenge were calculated. Overall sensitivity and specificity of acute L-dopa challenge to predict clinical diagnosis of PD was 70.9% and 81.4%, respectively; positive predictive ratio was 88.6%. When patients were divided into three groups according to their UPDRS motor section score at initial examination, sensitivity and specificity varied: Group I (or=21), 36.4% and 87%, respectively. Positive predictive ratio increased to 100% in Group I and to 87.5% in Group III. 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