Objective: aimed to confirm the diagnostic value/accuracy of levodopa and/or apomorphine challenge test in parkinsonian syndromes (PDS) to assess their value in the diagnosis of iPD.

Background: Clinical symptoms of early idiopathic Parkinson’s disease (iPD) and other parkinsonism can overlap, resulting in a high rate of clinical misdiagnosis.

Method: The PubMed, Embase, Web of Science and Cochrane Library databases were searched for articles published up to 14 February 2023. Studies reporting levodopa and/or apomorphine challenge test in PDS were included. UPDRS scores improvement rates, values after the acute levodopa challenge tests (LCTs), pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under curve (AUC)were calculated.The PubMed, Embase, Web of Science and Cochrane Library databases were searched for articles published up to 14 February 2023. Studies reporting levodopa and/or apomorphine challenge test in PDS were included. UPDRS scores improvement rates, values after the acute levodopa challenge tests (LCTs), pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under curve (AUC)were calculated.

Results: We ultimately included 50 studies. Pooled sensitivity and specificity (95% CI) were 0.82 (0.76-0.87) and 0.77 (0.69-0.836) for acute LCT, 0.76 (0.60-0.89) and 0.90 (0.74-0.96) for chronic levodopa therapy and 0.92 (0.83-0.96) and 0.74 (0.63-0.83) for acute apomorphine challenge test. Pooled DOR (95% confidence interval) were 14.11 (8.7-22.8) for acute LCT, 14.88 (4.22-52.39) for chronic levodopa therapy and 31.8 (10.27-94.08) for acute apomorphine challenge test. The AUC were 0.835 for acute  LCT, 0.692 for chronic levodopa therapy and 0.834 for acute apomorphine challenge test. The UPDRS score improvement rate was 32.65%, (95% CI 28.33–36.96), and the UPDRS score improved by 13.97, (95% CI 10.31–17.63) in PD after the acute LCT. While the scores improvement rate was 12.45%, (95% CI 5.42–19.48), and the UPDRS score improved by 3.63, (95% CI 1.12–6.14) in other PDS.

Conclusion: There are significant differences in UPDRS scores improvement rates and improvement values between PD and other PDS after the acute LCTs. Acute LCT, chronic levodopa therapy and acute apomorphine challenge test are all effective in diagnosing idiopathic Parkinson’s disease. Acute LCT had the highest diagnostic potency of the three groups.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-diagnosis-value-of-dopaminergic-responsiveness-of-parkinsons-disease%ef%bc%9a-a-systematic-review-and-meta-analysis/