Levodopa response key predictor

In Parkinson's disease, patients' best response to levodopa is the strongest predictor of the effectiveness of deep brain stimulation in treating motor fluctuations and dyskinesia, Australian experts say. New national referral guidelines state that in general, the procedure provides improvements similar to those achieved with the patient's best response to levodopa. Excluding tremor, non-levodopa-responsive symptoms generally did not improve with deep brain stimulation, the experts said. However, patients who experienced severe dyskinesia, despite a poor levodopa response, either as a manifestation of advanced Parkinson's or atypical Parkinsonian syndromes, may be considered for pallidal deep brain stimulation as an anti-dyskinetic procedure. Symptomatic profile and absence of contraindications, such as psychiatric comorbitidies, were the major determinants of suitability for the procedure. Disease duration per se was not a determinant, however longer disease duration was associated with higher prevalence of non-levodopa-responsive and non-motor symptoms, which may preclude patients from surgery. Age was not usually a reason to exclude a patient, but the relative benefit of subthalamic nucleus deep brain stimulation might be reduced in patients over 70, the guidelines said. Journal of Clinical Neuroscience 2009; 16:1001-08. Australian Doctor...