Value of Clinical Signs in Identifying Patients with Scans without Evidence of Dopaminergic Deficit (SWEDD)

Suwijn, Sven R.; Samim, Hamdia; Eggers, Carsten; Espay, Alberto J.; Fox, Susan H.; Lang, Anthony E.; Samuel, Mike; Silverdale, Monty; Verschuur, Constant V. M.; Dijk, J. Marc C. van; Verberne, Hein J.; Booij, Jan; Bie, Rob M.A. de

doi:10.3233/jpd-202090

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…The baseline characteristics of the patients in the early- and delayed-start groups included in the intention-to-treat analyses and the per-protocol analyses were comparable (Table 1). Dopamine transporter single-photon emission CT imaging was performed in 191 patients because of participation in an ancillary diagnostic accuracy study 9 or as a part of standard clinical care. Of these 191 patients, 4 had a scan without evidence of dopaminergic deficiency.…”

Section: Resultsmentioning

confidence: 99%

Levodopa Response in Patients With Early Parkinson Disease

et al. 2023

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Background and objectives:The Levodopa in EArly Parkinson´s disease (LEAP) study enabled us to conduct post-hoc analyses concerning the effects of levodopa in patients with early Parkinson’s disease.Methods:The LEAP-study was a double-blind, placebo-controlled, randomized, delayed-start trial in which patients with early Parkinson’s disease were randomized to receive levodopa/carbidopa 300/75 mg daily for 80 weeks (early-start group) or to placebo for 40 weeks followed by levodopa/carbidopa 300/75 mg daily for 40 weeks (delayed-start group). We analyzed the effect of levodopa with the Unified Parkinson’s Disease Rating Scale on bradykinesia, rigidity, and tremor. At week 80, participants answered three questions regarding motor response fluctuations.Results:A total of 222 patients were randomized to the early-start group (mean±SD age at baseline 64.8±8.7 years; 71% male) and 223 to the delayed-start group (mean±SD age at baseline 65.5±8.8 years; 69% male). The difference between the early and delayed-start group in mean change from baseline to week four, expressed as Hedges’geffect size, was -0.33 for bradykinesia, -0.29 for rigidity, and -0.25 for tremor (for all symptoms indicating a small effect in favor of the early-start group); from baseline to week 22 respectively -0.49, -0.36, and -0.44 (small to medium effect); and from baseline to week 40 respectively -0.32, -0.19, and -0.27 (small effect). At 80 weeks, fewer patients in the early-start group (46 of 205 patients, 23%) experienced motor response fluctuations than patients in the delayed-start group (81 of 211, 38%; p<0.01).Discussion:In patients with early Parkinson’s disease levodopa improves bradykinesia, rigidity, and tremor to the same order of magnitude. For all three symptoms, effects were larger at 22 weeks compared to four weeks. At 80 weeks there were fewer patients with motor response fluctuations in the group that had started levodopa earlier.Classification of evidence:This study provides Class II evidence that the effect of levodopa on bradykinesia, rigidity and tremor is larger after 22 weeks compared to four weeks of treatment.Trial registration LEAP-study:ISRCTN30518857, EudraCT number 2011-000678-72

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Section: Resultsmentioning

confidence: 99%

Levodopa Response in Patients With Early Parkinson Disease

et al. 2023

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“…The value of clinical signs in identifying patients was found to be poor (low intraclass correlation coefficients). The worst clinical assessments were made by GNs (33.3%) and NTs (50%), and the best by MDEs (66.7%) [18]. However, this actually confirms the necessity of training in clinical assessment of parkinsonism rather than performing obligatory DaTSCAN at early PD stage.…”

Section: Clinical Reasoningmentioning

confidence: 85%

Neuroimaging in Parkinson’s Disease: necessity or exaggeration?

Śmiłowska

Burzyńska-Makuch

Brockhuis

et al. 2021

Neurol Neurochir Pol.

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Introduction:Neuroimaging play an increasingly important role in the diagnosis of parkinsonian syndromes.Aim of the study: In this paper, the authors elaborate on the necessity of using magnetic resonance imaging (MRI) in Parkinson's Disease (PD) and its potential role in differential diagnosis versus other neurodegenerative parkinsonian syndromes such as dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy and corticobasal syndrome. State of the art:The currently known characteristic abnormalities are listed and tabulated, current recommendations are summarised and sample images are provided. As routine MRI scanning in PD remains controversial, the authors' aim is to show the pros and cons in clinical practice. Additionally, the rationale for functional imaging examination, including [ 123 I]-FP-CIT SPECT (DaTSCAN) and [99mTc]-HMPAO-SPECT, [ 18 F]-FDG-PET, [ 123 I]-mIBG-SPECT is discussed. Clinical vignette:This paper is accompanied by two illustrative clinical cases in which neuroimaging studies played a key role in diagnosis and further management. Conclusions:Neuroimaging can be helpful in differentiating PD from both atypical and symptomatic parkinsonism. Nevertheless, extensive neurological assessment in a majority of PD cases is sufficient to make a diagnosis. A network of specialists in movement disorders should be established in order to enable better, faster and more precise diagnosis of parkinsonism.

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