Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Krembil Brain Institute, Toronto, Ontario, Canada.
Eur J Neurol. 2022 Dec;29(12):3742-3747. doi: 10.1111/ene.15539. Epub 2022 Sep 12.
While levodopa is the most effective symptomatic treatment for Parkinson's disease (PD), its use is associated with an increased risk of motor complications (MCs) in the first 5 years of treatment compared to dopamine agonist (DA) first therapy. It is not known whether this translates into true benefit later in the disease. We aimed to determine whether there is a difference in the time between initial levodopa versus DA treatment and the development of disabling MCs prompting deep brain stimulation (DBS) consideration.
This was a retrospective cohort study of patients with PD attending the DBS Clinic at Toronto Western Hospital, Canada between March 2004 and February 2022, who underwent globus pallidus interna (GPI) or subthalamic nucleus (STN) DBS in 2005 or later for disabling MCs.
Of the 438 patients included in the study, 352 underwent STN DBS and 86 underwent GPi DBS. The median (range) disease duration was 9 (2-30) years. The majority of patients (n = 312) received levodopa first and 126 received a DA. There was no significant difference in disease duration or amantadine use between the two groups. The duration from the first treatment to assesment for DBS (levodopa: median 8 years, interquartile range [IQ] 4 years; DA: median 9, IQR 4 years) or DBS surgery (levodopa: median 10 years, IIQR 5 years; DA: median 10 years, IQR 5 years) did not differ.
To our knowledge, this is the only study to date to evaluate the duration between levodopa/DA-first treatment and the development of MCs of sufficient severity to warrant consideration of DBS. No association was found. The results suggest that the development of disabling MCs warranting DBS is independent of the type of first dopaminergic treatment.
左旋多巴是治疗帕金森病（PD）最有效的对症治疗药物，但与多巴胺激动剂（DA）作为一线治疗相比，在治疗的前 5 年内，其使用与运动并发症（MCs）的风险增加相关。目前尚不清楚这是否会在疾病后期带来真正的益处。我们旨在确定在初始左旋多巴与 DA 治疗之间的时间差异，以及发展到需要深脑刺激（DBS）考虑的致残性 MCs 之间是否存在差异。
这是一项回顾性队列研究，纳入了 2004 年 3 月至 2022 年 2 月期间在加拿大多伦多西部医院 DBS 诊所就诊的 PD 患者，这些患者在 2005 年或之后因致残性 MCs 接受了苍白球内侧（GPI）或丘脑底核（STN）DBS。
本研究共纳入 438 例患者，其中 352 例行 STN DBS，86 例行 GPi DBS。中位（范围）病程为 9（2-30）年。大多数患者（n=312）接受左旋多巴治疗，126 例接受 DA 治疗。两组间疾病持续时间或金刚烷胺使用无显著差异。从首次治疗到评估 DBS（左旋多巴：中位数 8 年，四分位距[IQR]4 年；DA：中位数 9 年，IQR 4 年）或 DBS 手术（左旋多巴：中位数 10 年，IQR 5 年；DA：中位数 10 年，IQR 5 年）的时间无差异。
据我们所知，这是迄今为止唯一一项评估左旋多巴/DA 一线治疗与严重程度足以考虑 DBS 的 MCs 发展之间的时间间隔的研究。未发现相关性。结果表明，致残性 MCs 的发展与 DBS 的必要性与一线多巴胺能治疗的类型无关。
