Wider Christian, Russmann Heike, Villemure Jean-Guy, Robert Bernadette, Bogousslavsky Julien, Burkhard Pierre R, Vingerhoets François J G
Department of Neurology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
Arch Neurol. 2006 Jul;63(7):951-5. doi: 10.1001/archneur.63.7.951.
Long-duration response (LDR) to levodopa is supposed to decrease with Parkinson disease (PD) progression, but direct observation of this response in advanced PD has never been performed.
To study the LDR to levodopa in patients with advanced PD treated with subthalamic deep brain stimulation (DBS).
We studied 30 consecutive patients with PD who underwent subthalamic DBS. One group had no antiparkinsonian treatment since surgery (no-levodopa group), whereas medical treatment had to be reinitiated in the other group (levodopa group).
Motor subscale score of the Unified Parkinson's Disease Rating Scale.
Compared with preoperative assessment, evaluation 6 months postoperatively with DBS turned off for 3 hours found a worsening of the motor subscale score of the Unified Parkinson's Disease Rating Scale in the no-levodopa group. This worsening being absent in the levodopa group, it probably reflected the loss of the LDR to levodopa in the no-levodopa group. When DBS was turned on, postoperative motor subscale scores of the Unifid Parkinson's Disease Rating Scale in both groups were similar to preoperative scores while receiving medication, suggesting that subthalamic DBS compensated for the short-duration response and LDR to levodopa.
Our results suggest that the LDR to levodopa remains significant even in advanced PD, and that subthalamic DBS compensates for the short-duration response and LDR to levodopa.
左旋多巴的长期反应（LDR）被认为会随着帕金森病（PD）的进展而降低，但从未对晚期PD患者的这种反应进行过直接观察。
研究接受丘脑底核深部脑刺激（DBS）治疗的晚期PD患者对左旋多巴的LDR。
我们研究了30例连续接受丘脑底核DBS治疗的PD患者。一组自手术以来未接受抗帕金森治疗（无左旋多巴组），而另一组则必须重新开始药物治疗（左旋多巴组）。
统一帕金森病评定量表的运动子量表评分。
与术前评估相比，术后6个月在DBS关闭3小时的情况下进行评估发现，无左旋多巴组统一帕金森病评定量表的运动子量表评分恶化。左旋多巴组未出现这种恶化情况，这可能反映了无左旋多巴组对左旋多巴的LDR丧失。当DBS开启时，两组统一帕金森病评定量表术后运动子量表评分在接受药物治疗时与术前评分相似，这表明丘脑底核DBS补偿了对左旋多巴的短期反应和LDR。
我们的结果表明，即使在晚期PD中，对左旋多巴的LDR仍然显著，并且丘脑底核DBS补偿了对左旋多巴的短期反应和LDR。
