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Ye L, Sani SS, Veith Sanches L, Krey LFM, Wegner F, Höllerhage M, Schrader C, Höglinger G, Klietz M. Acute Levodopa Challenge in Atypical Parkinsonism: Comprehensive Analysis of Individual Motor Responses. Brain Sci 2024; 14:991. [PMID: 39452005 PMCID: PMC11506334 DOI: 10.3390/brainsci14100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 09/19/2024] [Accepted: 09/25/2024] [Indexed: 10/26/2024] Open
Abstract
The acute levodopa challenge is widely used to distinguish Parkinson's disease (PD) from atypical parkinsonian syndromes (APSs) such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). In APSs, very few patients present a clinically relevant response to levodopa. The aim of this study was to determine whether patients with atypical parkinsonism benefit from levodopa in any aspect of their multiple motor deficits despite the generally poor response. This retrospective study analyzed individual motor responses to the acute levodopa challenge using the MDS-UPDRS III in 47 PSP, 26 MSA, and 71 PD patients at Hannover Medical School. Despite the generally poor levodopa response in both PSP and MSA patients, bradykinesia and rigidity were the symptoms most notably affected by levodopa in PSP patients, while MSA patients experienced significant improvements in bradykinesia and action tremor. These findings underscore the variability in levodopa response among PSP and MSA patients and highlight the need for personalized treatment approaches in atypical parkinsonism.
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Affiliation(s)
- Lan Ye
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
| | - Sam Sadeghi Sani
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
| | - Linda Veith Sanches
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
| | - Lea Farina Magdalena Krey
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
| | - Matthias Höllerhage
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
| | - Christoph Schrader
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
| | - Günter Höglinger
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
- Department of Neurology, LMU University Hospital, LMU Munich, 80539 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80539 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 80539 Munich, Germany
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (S.S.S.); (L.V.S.); (L.F.M.K.); (F.W.); (M.H.); (C.S.); (G.H.); (M.K.)
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