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Effect of Subthalamic Deep Brain Stimulation on Levodopa-Induced Dyskinesia in Parkinson's Disease.

Kim JH, Chang WS, Jung HH, Chang JW - Yonsei Med. J. (2015)

Bottom Line: The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients.Group 2 was further divided by the location of DBS leads.Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

View Article: PubMed Central - PubMed

Affiliation: Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on levodopa-induced peak-dose dyskinesia in patients with Parkinson's disease (PD).

Materials and methods: A retrospective review was conducted on patients who underwent STN DBS for PD from May 2000 to July 2012. Only patients with levodopa-induced dyskinesia prior to surgery and more than 1 year of available follow-up data after DBS were included. The outcome measures included the dyskinesia subscore of the Unified Parkinson's Disease Rating Scale (UPDRS) part IV (items 32 to 34 of UPDRS part IV) and the levodopa equivalent daily dose (LEDD). The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients. Group 2 was further divided by the location of DBS leads.

Results: Of the 100 patients enrolled, 67 were in Group 1, while those remaining were in Group 2. Twelve months after STN DBS, Groups 1 and 2 showed improvements of 61.90% and 57.14%, respectively, in the dyskinesia subscore. Group 1 was more likely to experience dyskinesia suppression; however, the association between the groups and dyskinesia suppression was not statistically significant (p=0.619). In Group 2, dyskinesia was significantly decreased by stimulation of the area above the STN in 18 patients compared to stimulation of the STN in 15 patients (p=0.048).

Conclusion: Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

No MeSH data available.


Related in: MedlinePlus

The mean improvement of dyskinesia was reduced by 73.57% (from 3.44 preoperatively to 0.83 postoperatively) in patients with stimulation of the area above the STN, whereas the mean improvement of dyskinesia was reduced by only 37.44% (from 5.40 preoperatively to 3.07 postoperatively) in patients where the STN was directly stimulated. There was a significant difference between stimulation of the area above the STN and within the STN. STN, subthalamic nucleus.
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Figure 2: The mean improvement of dyskinesia was reduced by 73.57% (from 3.44 preoperatively to 0.83 postoperatively) in patients with stimulation of the area above the STN, whereas the mean improvement of dyskinesia was reduced by only 37.44% (from 5.40 preoperatively to 3.07 postoperatively) in patients where the STN was directly stimulated. There was a significant difference between stimulation of the area above the STN and within the STN. STN, subthalamic nucleus.

Mentions: Analysis of Group 2 revealed that 18 patients had an active contact above the STN, including within the zona incerta, and 15 patients had an active contact within the STN. The mean improvements of the dyskinesia subscores in patients with stimulation above the STN and within the STN after 12 months were 73.57% and 37.44%, respectively. Dyskinesia was significantly attenuated by stimulation of the area above the STN in 18 patients when compared to stimulation of the STN itself in 15 patients (p=0.048) (Fig. 2).


Effect of Subthalamic Deep Brain Stimulation on Levodopa-Induced Dyskinesia in Parkinson's Disease.

Kim JH, Chang WS, Jung HH, Chang JW - Yonsei Med. J. (2015)

The mean improvement of dyskinesia was reduced by 73.57% (from 3.44 preoperatively to 0.83 postoperatively) in patients with stimulation of the area above the STN, whereas the mean improvement of dyskinesia was reduced by only 37.44% (from 5.40 preoperatively to 3.07 postoperatively) in patients where the STN was directly stimulated. There was a significant difference between stimulation of the area above the STN and within the STN. STN, subthalamic nucleus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541661&req=5

Figure 2: The mean improvement of dyskinesia was reduced by 73.57% (from 3.44 preoperatively to 0.83 postoperatively) in patients with stimulation of the area above the STN, whereas the mean improvement of dyskinesia was reduced by only 37.44% (from 5.40 preoperatively to 3.07 postoperatively) in patients where the STN was directly stimulated. There was a significant difference between stimulation of the area above the STN and within the STN. STN, subthalamic nucleus.
Mentions: Analysis of Group 2 revealed that 18 patients had an active contact above the STN, including within the zona incerta, and 15 patients had an active contact within the STN. The mean improvements of the dyskinesia subscores in patients with stimulation above the STN and within the STN after 12 months were 73.57% and 37.44%, respectively. Dyskinesia was significantly attenuated by stimulation of the area above the STN in 18 patients when compared to stimulation of the STN itself in 15 patients (p=0.048) (Fig. 2).

Bottom Line: The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients.Group 2 was further divided by the location of DBS leads.Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

View Article: PubMed Central - PubMed

Affiliation: Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on levodopa-induced peak-dose dyskinesia in patients with Parkinson's disease (PD).

Materials and methods: A retrospective review was conducted on patients who underwent STN DBS for PD from May 2000 to July 2012. Only patients with levodopa-induced dyskinesia prior to surgery and more than 1 year of available follow-up data after DBS were included. The outcome measures included the dyskinesia subscore of the Unified Parkinson's Disease Rating Scale (UPDRS) part IV (items 32 to 34 of UPDRS part IV) and the levodopa equivalent daily dose (LEDD). The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients. Group 2 was further divided by the location of DBS leads.

Results: Of the 100 patients enrolled, 67 were in Group 1, while those remaining were in Group 2. Twelve months after STN DBS, Groups 1 and 2 showed improvements of 61.90% and 57.14%, respectively, in the dyskinesia subscore. Group 1 was more likely to experience dyskinesia suppression; however, the association between the groups and dyskinesia suppression was not statistically significant (p=0.619). In Group 2, dyskinesia was significantly decreased by stimulation of the area above the STN in 18 patients compared to stimulation of the STN in 15 patients (p=0.048).

Conclusion: Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

No MeSH data available.


Related in: MedlinePlus