RT Journal Article
SR Electronic
T1 Systematic review of acute levodopa and apomorphine challenge tests in the diagnosis of idiopathic Parkinson's disease
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 590
OP 594
DO 10.1136/jnnp.69.5.590
VO 69
IS 5
A1 C E Clarke
A1 P Davies
YR 2000
UL http://jnnp.bmj.com/content/69/5/590.abstract
AB OBJECTIVES To perform a systematic review of studies examining the diagnostic accuracy of acute challenge tests with levodopa and/or apomorphine in parkinsonian syndromes to assess their value in the diagnosis of idiopathic Parkinson's disease. METHODS A literature search including Medline and the Cochrane Library was performed for studies published in any language comparing acute levodopa and/or apomorphine response with chronic levodopa therapy in parkinsonian syndromes. Abstracted sensitivity and specificity data were summarised using variance weighting and conditional logistic regression for studies comparing two challenge tests. RESULTS Thirteen studies were located: four examining de novo patients and nine examining patients with well established idiopathic Parkinson's disease and non-parkinsonian conditions. Despite the significant heterogeneity in the methodologies employed, the comparable results suggest that this had little effect on the accuracy of the tests. The sensitivity for the diagnosis of established idiopathic Parkinson's disease was: apomorphine 0.86 (95% confidence interval (95% CI) 0.78–0.94), acute levodopa 0.75 (95% CI 0.64–0.85), and chronic levodopa therapy 0.91 (95% CI 0.85–0.99). The specificity for the diagnosis of established idiopathic Parkinson's disease was: apomorphine 0.85 (95% CI 0.74–0.96), acute levodopa 0.87 (95% CI 0.77–0.97), and chronic levodopa therapy 0.77 (95% CI 0.61–0.93). The number of patients positive for each test divided by the number with clinically diagnosed de novo disease was: apomorphine 0.63 (95% CI 0.56–0.70), acute levodopa 0.69 (95% CI 0.59–0.80), and chronic levodopa therapy 0.76 (95% CI 0.70–0.82). CONCLUSIONS The accuracy of the acute levodopa and apomorphine challenge tests is similar to, but not superior than, that of chronic levodopa therapy in the diagnosis of idiopathic Parkinson's disease. As most patients will be given chronic dopamimetic therapy, these tests add nothing while causing significant adverse events and additional cost.