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. 2014 Apr 14;9(4):e94856.
doi: 10.1371/journal.pone.0094856. eCollection 2014.

The "brittle response" to Parkinson's disease medications: characterization and response to deep brain stimulation

Daniel Martinez-Ramirez  1 , Juan Giugni  1 , Vinata Vedam-Mai  2 , Aparna Wagle Shukla  1 , Irene A Malaty  1 , Nikolaus R McFarland  1 , Ramon L Rodriguez  1 , Kelly D Foote  3 , Michael S Okun  2
Affiliations

The "brittle response" to Parkinson's disease medications: characterization and response to deep brain stimulation

Daniel Martinez-Ramirez et al. PLoS One. .

Abstract

Objective: Formulate a definition and describe the clinical characteristics of PD patients with a "brittle response" (BR) to medications versus a "non-brittle response" (NBR), and characterize the use of DBS for this population.

Methods: An UF IRB approved protocol used a retrospective chart review of 400 consecutive PD patients presenting to the UF Center for Movement Disorders and Neurorestoration. Patient records were anonymized and de-identified prior to analysis. SPSS statistics were used to analyze data.

Results: Of 345 included patients, 19 (5.5%) met criteria for BR PD. The BR group was comprised of 58% females, compared to 29% in the NBR group (P = .008). The former had a mean age of 63.4 compared to 68.1 in the latter. BR patients had lower mean weight (63.5 vs. 79.6, P = <.001), longer mean disease duration (12.6 vs. 8.9 years, P = .003), and had been on LD for more years compared to NBR patients (9.8 vs. 5.9, P = .001). UPDRS motor scores were higher (40.4 vs. 30.0, P = .001) in BR patients. No differences were observed regarding the Schwab and England scale, PDQ-39, and BDI-II. Sixty-three percent of the BR group had undergone DBS surgery compared to 18% (P = .001). Dyskinesias were more common, severe, and more often painful (P = <.001) in the BR group. There was an overall positive benefit from DBS.

Conclusion: BR PD occurred more commonly in female patients with a low body weight. Patients with longer disease duration and longer duration of LD therapy were also at risk. The BR group responded well to DBS.

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Conflict of interest statement

Competing Interests: The following authors have declared that no competing interests exist. Daniel Martinez-Ramirez, Juan Giugni, Vinata Vedam-Mai, Aparna Wagle Shukla. Irene Malaty has received support from the National Parkinson Foundation and Michael J. Fox Foundation as well as Tourette Syndrome Association for Parkinson and Tourette syndrome related research. She also has participated in research funded by NIH, NINDS, Abbott, Acadia, Allergan, Biote, Inc., Dystonia Study Group, EMD-Sorono, IPSEN, Merz, Neuropace, Office of Rare Disease Research (ORDR) and TEVA, but has no owner interest in any pharmaceutical company. Dr. Malaty has also received honoraria from PRIME CME, the National Parkinson Foundation, and the Tourette Syndrome Association for speaking, with full control of content. Nikolaus McFarland receives grant support from NIH. Ramon Rodriguez has received research support from Abbott, Biotie Therapeutics, EMD-Serono, Huntington Study Group, Ipsen, Merz Pharmaceuticals, Allergan, National Parkinson Foundation, NIH/NINDS, Teva, but has no owner interest in any pharmaceutical company. Over the last 12 months, Dr. Rodriguez has received honoraria from PeerView Institute for Medical Education, PRIME CME, Corporate Meeting Solutions, Merz Pharmaceuticals. The University of Florida Clinic has contracts with Allergan for education services provided by Dr. Rodriguez, but he does not receive any personal compensation for these roles. Kelly Foote receives grant support from NIH, NPF and University of Florida Foundation. Michael Okun consults for the National Parkinson Foundation, Journal Watch, and receives grant support from NIH, NPF, Michael J. Fox Foundation, and Bachmann-Strauss Dystonia & Parkinson Foundation, Inc. He has received no industry-related honoraria for >36 months. He has participated in CME activities for PeerView, Prime, USF CME, and Vanderbilt CME. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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References

    1. Warren Olanow C, Kieburtz K, Rascol O, Poewe W, Schapira AH, et al. (2013) Factors predictive of the development of Levodopa-induced dyskinesia and wearing-off in Parkinson’s disease. Mov Disord 28: 1064–1071. - PubMed
    1. Voulgari C, Pagoni S, Paximadas S, Vinik AI (2012) “Brittleness” in diabetes: easier spoken than broken. Diabetes Technol Ther 14: 835–848. - PubMed
    1. McLellan DL, Dean BC (1982) Improved control of brittle Parkinsonism by separate administration of levodopa and benserazide. Br Med J (Clin Res Ed) 284: 1001–1002. - PMC - PubMed
    1. Oh JY, Kim YS, Choi BH, Sohn EH, Lee AY (2009) Relationship between clinical phenotypes and cognitive impairment in Parkinson’s disease (PD). Arch Gerontol Geriatr 49: 351–354. - PubMed
    1. Mouradian MM, Heuser IJ, Baronti F, Chase TN (1990) Modification of central dopaminergic mechanisms by continuous levodopa therapy for advanced Parkinson’s disease. Ann Neurol 27: 18–23. - PubMed

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