INVESTIGADORES
PEREZ LLORET Santiago
congresos y reuniones científicas
Título:
Intolerance to Acute Levodopa Challenge: a Tool for Clinical Diagnosis of MSA?
Autor/es:
S. ESTÉVEZ; S. PÉREZ- LLORET; M. MERELLO
Lugar:
Chicago
Reunión:
Congreso; Congreso Internacional de Movimientos Anormales; 2008
Resumen:
Objective: To determine if DS or sleepiness may be related to differences in basal
ganglia and brainstem pathology between different parkinsonian disorders, revealing
the existence of a predisposing autonomic dysfunction, and therefore determine its
usefulness in the diagnosis of MSA.To determine if DS or sleepiness may be related to differences in basal
ganglia and brainstem pathology between different parkinsonian disorders, revealing
the existence of a predisposing autonomic dysfunction, and therefore determine its
usefulness in the diagnosis of MSA.
Background: Overall sensitivity and specificity of acute L-dopa challenge to predict
clinical diagnosis of PD is 70.9% and 81.4%, respectively. A significant number of
patients who undergo an acute L-dopa challenge, even if pre-treated with
Domperidone, develop sleepiness and disautonomic symptoms (DS) such as nausea,
vomiting, hypotension and profuse perspiration.Overall sensitivity and specificity of acute L-dopa challenge to predict
clinical diagnosis of PD is 70.9% and 81.4%, respectively. A significant number of
patients who undergo an acute L-dopa challenge, even if pre-treated with
Domperidone, develop sleepiness and disautonomic symptoms (DS) such as nausea,
vomiting, hypotension and profuse perspiration.
Methods: 507 Dopaminergic Acute Challenge Tests performed for different purposes
in the last ten years in a movement disorders clinic were revisited, searching for those
patients who manifested DS during test performance. Only those tests with diagnostic
purpose were included and matched by test result, sex, and age, with a group of
patients undergoing acute challenge without any DS. Presumptive diagnosis for each
patient was performed by means of clinical accepted criteria after a significant followup
period. Only patients with final diagnosis of IPD or MSA were analyzed. Data were
comapared by chi-square test. Sensitivity, specificity, predictive values and likelihood
ratios as were as their 95% confidence intervals (95%CI) were calculated.507 Dopaminergic Acute Challenge Tests performed for different purposes
in the last ten years in a movement disorders clinic were revisited, searching for those
patients who manifested DS during test performance. Only those tests with diagnostic
purpose were included and matched by test result, sex, and age, with a group of
patients undergoing acute challenge without any DS. Presumptive diagnosis for each
patient was performed by means of clinical accepted criteria after a significant followup
period. Only patients with final diagnosis of IPD or MSA were analyzed. Data were
comapared by chi-square test. Sensitivity, specificity, predictive values and likelihood
ratios as were as their 95% confidence intervals (95%CI) were calculated.
Results: 53 patients of the 507 (10.4%) presented DS but only 23 of them (12 women
-52.2%-) received a final diagnosis of IPD or MSA, and underwent further analysis. The
test was considered positive in 11 cases (47.8%). Four out the 23 patients with DS
(17%) and 1 out the 16 patients from the control group (6%) were diagnosed as
having MSA (Chi-sq=1.05, p=0.3).Overall sensivity and specificity of DS to predict
diagnosis of MSA was 80% (95%IC: 45-100) and 44% (95%CI: 27-61) respectively.
Positive predictive value was 17% (95%CI: 2-33) while negative predictive value
achieved 94% (95%CI: 82-106). Postitive and negative likelihood ratios were 1.43
(95%CI: 0.84 - 2.43) and 0.45 (95%CI: 0.08-2.72).53 patients of the 507 (10.4%) presented DS but only 23 of them (12 women
-52.2%-) received a final diagnosis of IPD or MSA, and underwent further analysis. The
test was considered positive in 11 cases (47.8%). Four out the 23 patients with DS
(17%) and 1 out the 16 patients from the control group (6%) were diagnosed as
having MSA (Chi-sq=1.05, p=0.3).Overall sensivity and specificity of DS to predict
diagnosis of MSA was 80% (95%IC: 45-100) and 44% (95%CI: 27-61) respectively.
Positive predictive value was 17% (95%CI: 2-33) while negative predictive value
achieved 94% (95%CI: 82-106). Postitive and negative likelihood ratios were 1.43
(95%CI: 0.84 - 2.43) and 0.45 (95%CI: 0.08-2.72).
Conclusions: DS during L-dopa acute challenge doesn t help to differentiate
MSA from IPD patients.