AUTHOR=Lin Zhengyu , Zhang Xiaoxiao , Wang Linbin , Zhang Yingying , Zhou Haiyan , Sun Qingfang , Sun Bomin , Huang Peng , Li Dianyou 

TITLE=Revisiting the L-Dopa Response as a Predictor of Motor Outcomes After Deep Brain Stimulation in Parkinson’s Disease

JOURNAL=Frontiers in Human Neuroscience

VOLUME=15

YEAR=2021

URL=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2021.604433

DOI=10.3389/fnhum.2021.604433

ISSN=1662-5161

ABSTRACT=<p><bold>Objective:</bold> To investigate the correlation between preoperative response to the L-dopa challenge test and efficacy of deep brain stimulation (DBS) on motor function in Parkinson’s disease (PD).</p><p><bold>Methods:</bold> We retrospectively reviewed the data of 38 patients with idiopathic PD who underwent DBS surgery with a median follow-up duration of 7 months. Twenty underwent bilateral globus pallidus interna (GPi) DBS, and 18 underwent bilateral subthalamic nucleus (STN) DBS. The Movement Disorder Society Unified Parkinson Disease Rating Scale-Motor Part (MDS UPDRS-III) was assessed before surgery and at the last follow-up in different medication and stimulation conditions, respectively.</p><p><bold>Results:</bold> Pearson’s correlation analysis revealed a positive correlation between preoperative L-dopa challenge responsiveness and GPi-DBS responsiveness on the total score (<italic>R</italic><sup>2</sup> = 0.283, <italic>p</italic> = 0.016) but not on the non-tremor total score (<italic>R</italic><sup>2</sup> = 0.158, <italic>p</italic> = 0.083) of MDS UPDRS-III. Such correlation remained significant (<italic>R</italic><sup>2</sup>′ = 0.332, <italic>p</italic> = 0.010) after controlling for age at the time of surgery as confounding factor by partial correlation analysis. The preoperative L-dopa challenge responsiveness was significantly correlated with the tremor-controlling outcome of GPi-DBS (<italic>R</italic><sup>2</sup> = 0.390, <italic>p</italic> = 0.003). In contrast, we found a positive correlation between preoperative L-dopa challenge responsiveness and STN-DBS responsiveness on the non-tremor total score (<italic>R</italic><sup>2</sup> = 0.290, <italic>p</italic> = 0.021), but not on the total score (<italic>R</italic><sup>2</sup> = 0.130, <italic>p</italic> = 0.141) of MDS UPDRS-III. The partial correlation analysis further demonstrated that the predictive value of preoperative L-dopa challenge responsiveness on the non-tremor motor outcome of STN-DBS was eliminated (<italic>R</italic><sup>2</sup>′ = 0.120, <italic>p</italic> = 0.174) after controlling for age at the time of surgery as confounding factor.</p><p><bold>Interpretation:</bold> The short-term predictive value of preoperative response to the L-dopa challenge test for the motor outcome of GPi-DBS in PD was systematically described. Our findings suggest: (1) a solid therapeutic effect of GPi-DBS in treating L-dopa-responsive tremors; (2) a negative effect of age at the time of surgery on motor outcomes of STN-DBS, (3) a possible preference of STN- to GPi-DBS in L-dopa-resistant tremor control, and (4) a possible preference of GPi- to STN-DBS in elderly PD patients who have a satisfactory dopamine response.</p>