Reply: The variability of levodopa response in Parkinson's disease: Is sensitization reversible?

✍ Scribed by Elena Moro; Panida Piboolnurak; Anthony E. Lang; Andres M. Lozano; Janis M. Miyasaki; Jean A. Saint-Cyr; Yu-Yan W. Poon; William D. Hutchison; Jonathan O. Dostrovsky

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 27 KB
• Volume: 23
• Category: Article
• ISSN: 0885-3185
• DOI: 10.1002/mds.22030

✦ Synopsis

We thank Dr. Jabre and his colleagues for their comments concerning our article 1 and the reduction of the levodopa response after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in the long-term follow-up. We also agree that this partial loss of the levodopa clinical benefit after DBS surgery in advanced Parkinson's disease (PD) patients may be reversible, especially if due to the desensitization of dopamine receptors secondary to the postoperative marked reduction of dopaminergic treatment. Dr. Jabre and his colleagues' observation about their two STN-DBS patients, who gradually recovered the preoperative magnitude of the levodopa response within a few weeks of high-dose levodopa treatment (while waiting the pulse generator reimplantation), 2 is very interesting. It supports not only the concept of the clinical reversibility of DBS surgery but also possibly the rationale of performing STN-DBS earlier during the course of PD. 3 Indeed, an early STN-DBS intervention at the beginning of PD might prevent dopamine receptor modulation.