INVESTIGADORES
PEREZ LLORET Santiago
artículos
Título:
Does clinical intolerance to a diagnostic acute levodopa challenge differentiate multiple system atrophy from PD?
Autor/es:
SUSANA ESTEVEZ; SANTIAGO PEREZ-LLORET; MARCELO MERELLO
Revista:
THE INTERNATIONAL JOURNAL OF NEUROSCIENCE.
Editorial:
TAYLOR & FRANCIS LTD
Referencias:
Año: 2009 vol. 119 p. 2257 - 2261
ISSN:
0020-7454
Resumen:
BACKGROUND: The
diagnosis of multiple system atrophy (MSA) remains challenging.
Objective: To determine if the occurrence of symptoms of clinical
intolerance such as nausea, vomiting, hypotension, and profuse
perspiration during a standard acute levodopa challenge may be a useful
marker of MSA.
METHODS: A
total of 507 dopaminergic acute challenge tests performed for different
purposes in the last 10 years in a movement disorders clinic were
reviewed, identifying patients who manifested symptoms of clinical
intolerance during test performance. Only those tests completed for
diagnostic purposes were included and these were matched by the presence
or absence of response to levodopa, sex, and age, with a group of
patients undergoing acute challenge without any symptoms of clinical
intolerance. Presumptive diagnosis for each patient was performed by
means of accepted clinical criteria after a significant follow-up
period. Only patients with a final diagnosis of Parkinson's disease (PD)
or MSA were analyzed.
RESULTS: Twenty-three
out of the 507 patients (women: 50%) presented symptoms of clinical
intolerance and received a final diagnosis of PD or MSA, and underwent
further analysis. Four out the 23 patients with intolerance (17%) and
one out the 16 patients from the control group (6%) were diagnosed as
having MSA (Chi-square = 1.05, p = .3). Overall sensitivity and
specificity of the presence of clinical intolerance to predict diagnosis
of MSA were 80% (95%IC: 45%-100%) and 44% (95%CI: 27%-61%)
respectively.
CONCLUSIONS: Symptoms of clinical intolerance during an acute levodopa challenge do not appear to be useful in the diagnosis of MSA.