Levodopa and subthalamic deep brain stimulation responses are not congruent.
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.
Zaidel
Adam
A
The Interdisciplinary Center for Neural Computation, The Hebrew University of Jerusalem, Israel. adam@alice.nc.huji.ac.il
Bergman
Hagai
H
Ritov
Ya'acov
Y
Israel
Zvi
Z
D000978:Antiparkinson Agents / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa