The Interdisciplinary Center for Neural Computation, The Hebrew University of Jerusalem, Israel.
Mov Disord. 2010 Oct 30;25(14):2379-86. doi: 10.1002/mds.23294.
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.
目前有一种共识认为，在帕金森病中，术前左旋多巴反应的程度可以预测丘脑底核深部脑刺激（STN DBS）的疗效。然而，这可能是由于统计方法和主要假设造成的。我们能够在我们的数据（N = 49 名患者）上重现先前发表的相关性结果。然而，即使对我们的数据进行随机打乱，这些相同的结果也得到了证明。值得注意的是，当使用各自的基线和运动改善的分数时，我们并没有观察到 STN DBS 疗效与术前左旋多巴反应之间的相关性。此外，术后反应不受术前评分限制，震颤的差异最大。我们得出的结论是，术前左旋多巴反应不能预测或限制 STN DBS 的结果。这些结果表明左旋多巴和 STN DBS 的治疗机制不同，因此质疑将术前大量左旋多巴反应作为 STN DBS 的选择标准的有效性。
