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Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis.
Mov Disord. 2002 Jul; 17(4):795-8.MD

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= 10), 71.4% and 100%; Group II (11-20), 75% and 75%; and Group III (>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.

Authors+Show Affiliations

Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

12210878

Citation

Merello, Marcelo, et al. "Accuracy of Acute Levodopa Challenge for Clinical Prediction of Sustained Long-term Levodopa Response as a Major Criterion for Idiopathic Parkinson's Disease Diagnosis." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 17, no. 4, 2002, pp. 795-8.
Merello M, Nouzeilles MI, Arce GP, et al. Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis. Mov Disord. 2002;17(4):795-8.
Merello, M., Nouzeilles, M. I., Arce, G. P., & Leiguarda, R. (2002). Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis. Movement Disorders : Official Journal of the Movement Disorder Society, 17(4), 795-8.
Merello M, et al. Accuracy of Acute Levodopa Challenge for Clinical Prediction of Sustained Long-term Levodopa Response as a Major Criterion for Idiopathic Parkinson's Disease Diagnosis. Mov Disord. 2002;17(4):795-8. PubMed PMID: 12210878.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of acute levodopa challenge for clinical prediction of sustained long-term levodopa response as a major criterion for idiopathic Parkinson's disease diagnosis. AU - Merello,Marcelo, AU - Nouzeilles,Maria I, AU - Arce,Gabriel Piran, AU - Leiguarda,Ramón, PY - 2002/9/5/pubmed PY - 2002/11/26/medline PY - 2002/9/5/entrez SP - 795 EP - 8 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 17 IS - 4 N2 - 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= 10), 71.4% and 100%; Group II (11-20), 75% and 75%; and Group III (>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. SN - 0885-3185 UR - https://www.unboundmedicine.com/medline/citation/12210878/Accuracy_of_acute_levodopa_challenge_for_clinical_prediction_of_sustained_long_term_levodopa_response_as_a_major_criterion_for_idiopathic_Parkinson's_disease_diagnosis_ L2 - https://doi.org/10.1002/mds.10123 DB - PRIME DP - Unbound Medicine ER -