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Parkinson's disease tremor differentially responds to levodopa and subthalamic stimulation

Wirth, Thomas; Ferreira, Francisca; Vijiaratnam, Nirosen; Girges, Christine; Pakzad, Ashkan; de Roquemaurel, Alexis; Sinani, Olga; ... Foltynie, Thomas; + view all (2023) Parkinson's disease tremor differentially responds to levodopa and subthalamic stimulation. Movement Disorders Clinical Practice , 10 (11) pp. 1639-1649. 10.1002/mdc3.13876.

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Abstract

BACKGROUND: Tremor in Parkinson's disease (PD) has an inconsistent response to levodopa and subthalamic deep brain stimulation (STN-DBS). OBJECTIVES: To identify predictive factors of PD tremor responsiveness to levodopa and STN-DBS. MATERIAL AND METHODS: PD patients with upper limb tremor who underwent STN-DBS were included. The levodopa responsiveness of tremor (overall, postural, and rest sub-components), was assessed using the relevant Unified Parkinson's Disease Rating Scale-III items performed during the preoperative assessment. Post-surgical outcomes were similarly assessed ON and OFF stimulation. A score for the rest/postural tremor ratio was used to determine the influence of rest and postural tremor severity on STN-DBS outcome. Factors predictive of tremor responsiveness were determined using multiple linear regression modeling. Volume of tissue activated measurement coupled to voxel-based analysis was performed to identify anatomical clusters associated with motor symptoms improvement. RESULTS: One hundred and sixty five patients were included in this study. Male gender was negatively correlated with tremor responsiveness to levodopa, whereas the ratio of rest/postural tremor was positively correlated with both levodopa responsiveness and STN-DBS tremor outcome. Clusters corresponding to improvement of tremor were in the subthalamic nucleus, the zona incerta and the thalamus, whereas clusters corresponding to improvement for akinesia and rigidity were located within the subthalamic nucleus. CONCLUSION: More severe postural tremor and less severe rest tremor were associated with both poorer levodopa and STN-DBS response. The different locations of clusters associated with best correction of tremor and other parkinsonian features suggest that STN-DBS effect on PD symptoms is underpinned by the modulation of different networks.

Type: Article
Title: Parkinson's disease tremor differentially responds to levodopa and subthalamic stimulation
DOI: 10.1002/mdc3.13876
Publisher version: https://doi.org/10.1002/mdc3.13876
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: Parkinson's disease, tremor, subthalamic stimulation, levodopa, volume of tissue activated
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences
URI: https://discovery.ucl.ac.uk/id/eprint/10177228
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