Quantitative Assessment of Motor Response to a Low Subacute Levodopa Dose in the Differential Diagnosis of Parkinsonisms at Disease Onset: Data from the BoProPark Cohort
| Autor: | Giovanna Calandra-Buonaura, Pietro Cortelli, Manuela Contin, Giovanna Lopane, Susan Mohamed, Luisa Sambati |
|---|---|
| Přispěvatelé: | Contin M., Lopane G., Cortelli P., Sambati L., Mohamed S., Calandra Buonaura G. |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
kinetics-dynamic Research Report Levodopa medicine.medical_specialty Parkinson's disease Gastroenterology Antiparkinson Agents Diagnosis Differential 03 medical and health sciences Cellular and Molecular Neuroscience 0302 clinical medicine Parkinsonian Disorders alternate finger tapping test Internal medicine medicine Humans kinetics-dynamics Prospective Studies Keywords: Levodopa Benserazide Receiver operating characteristic business.industry medicine.disease atypical parkinsonisms atypical parkinsonism Prospective Studie 030104 developmental biology Carbidopa Antiparkinson Agent Finger tapping Cohort Parkinson’s disease Neurology (clinical) Differential diagnosis business 030217 neurology & neurosurgery medicine.drug Human |
| Zdroj: | Journal of Parkinson's Disease |
| ISSN: | 1877-718X 1877-7171 |
| Popis: | Background: Differential diagnosis between Parkinson’s disease (PD) and atypical parkinsonisms (APs) may be difficult at disease onset. The response to levodopa (LD) is a key supportive feature but its definition is largely empirical. Studies evaluating this issue by quantitative tests are scanty. Objective: We aimed to assess the utility of a subacute low LD dose kinetic-dynamic test in the differential diagnosis between PD and APs. It was applied at the baseline of a prospective follow-up in patients with parkinsonian signs within three years of disease motor onset (“BoProPark” cohort) and eventually diagnosed as PD or APs according to consensus criteria. Methods: Patients under at least 3-month LD therapy received a first morning fasting dose of LD/benserazide or carbidopa (100/25 mg) and underwent simultaneous serial assessments of plasma LD concentration and alternate finger tapping frequency up to 3 h. The main outcome was the extent of LD motor response, calculated by the area under the 3 h tapping effect–time curve (AUC_ETap). A receiver operating characteristic (ROC) curve analysis was performed to establish the optimal AUC_ETap cut-off to differentiate PD and APs. Results: The first 100 consecutive “BoProPark” patients were analyzed. Forty-seven patients were classified as possible, 37 as probable PD and 16 as APs. AUC_ETap medians were similar in the PD subgroups but reduced to a third in APs (p 2186 [(tap/min) x min], with a sensitivity of 92% and a specificity of 75%. Accuracy of the test was 0.85 (95% CI 0.74–0.95), p |
| Databáze: | OpenAIRE |
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