Is Levodopa Response a Valid Indicator of Parkinson's Disease?

W. R.Wayne Martin, Michael Miles, Qiaonan Zhong, Johanna Hartlein, Brad A. Racette, Scott A. Norris, Mwiza Ushe, Baijayanta Maiti, Susan Criswell, Albert A. Davis, Paul T. Kotzbauer, Nigel J. Cairns, Richard J. Perrin, Joel S. Perlmutter

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: The clinical diagnosis of Parkinson's disease (PD) requires the presence of parkinsonism and supportive criteria that include a clear and dramatic beneficial response to dopaminergic therapy. Our aim was to test the diagnostic criterion of dopaminergic response by evaluating its association with pathologically confirmed diagnoses in a large population of parkinsonian patients. Methods: We reviewed clinical data maintained in an electronic medical record from all patients with autopsy data who had been seen in the Movement Disorders Center at Washington University, St. Louis, between 1996 and 2018. All patients with parkinsonism who underwent postmortem neuropathologic examination were included in this analysis. Results: There were 257 unique parkinsonian patients with autopsy-based diagnoses who had received dopaminergic therapy. Marked or moderate response to dopaminergic therapy occurred in 91.2% (166/182) of those with autopsy-confirmed PD, 52.0% (13/25) of those with autopsy-confirmed multiple systems atrophy, 44.4% (8/18) of those with autopsy-confirmed progressive supranuclear palsy, and 1 (1/8) with autopsy-confirmed corticobasal degeneration. Other diagnoses were responsible for the remaining 24 individuals, 9 of whom had a moderate response to dopaminergic therapy. Conclusion: A substantial response to dopaminergic therapy is frequent but not universal in PD. An absent response does not exclude PD. In other neurodegenerative disorders associated with parkinsonism, a prominent response may also be evident, but this occurs less frequently than in PD.

Original languageEnglish
Pages (from-to)948-954
Number of pages7
JournalMovement Disorders
Volume36
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • Parkinson's disease
  • diagnostic specificity
  • levodopa
  • parkinsonism

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