Levodopa and subthalamic deep brain stimulation responses are not congruent

• Published in: Movement disorders Vol. 25; no. 14; pp. 2379 - 2386
• Main Authors: Zaidel, Adam, Bergman, Hagai, Ritov, Ya'acov, MD, Zvi Israel
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 30.10.2010; Wiley
• Subjects: Antiparkinson Agents - therapeutic use; basal ganglia; Biological and medical sciences; deep brain stimulation; Deep Brain Stimulation - methods; Drug toxicity and drugs side effects treatment; Female; Humans; levodopa; Levodopa - therapeutic use; Male; Medical sciences; Neurology; Parkinson Disease - drug therapy; Parkinson Disease - physiopathology; Parkinson Disease - therapy; Parkinson's disease; Pharmacology. Drug treatments; predictive factor; Retrospective Studies; Severity of Illness Index; Statistics as Topic; subthalamic nucleus; Subthalamic Nucleus - physiology; Toxicity: nervous system and muscle; Treatment Outcome; Nervous system diseases; Parkinson's disease; basal ganglia; Deep brain stimulation; Central nervous system; Parkinson disease; Basal ganglion; Encephalon; Cerebral disorder; Central nervous system disease; Degenerative disease; Subthalamic nucleus; Levodopa; Predictive factor; Extrapyramidal syndrome
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.23294

There is a consensus that in Parkinson's disease, the extent of preoperative levodopa responsiveness predicts the efficacy of subthalamic nucleus deep brain stimulation (STN DBS). However, this may be the result of statistical methods and primary assumptions. We were able to reproduce previously published correlation results on our data (N = 49 patients). Yet, these same results were demonstrated even after random shuffling of our data. Notably, we did not observe a correlation between STN DBS efficacy and preoperative levodopa responsiveness when using their respective baselines and fractional scores of motor improvement. Furthermore, postoperative responses were not limited by preoperative scores, with tremor demonstrating the greatest discrepancy. We conclude that preoperative levodopa responsiveness does not predict or limit the outcome of STN DBS. These results imply different therapeutic mechanisms for levodopa and STN DBS and therefore question the validity of using substantial preoperative levodopa responsiveness as a selection criterion for STN DBS. © 2010 Movement Disorder Society