Levodopa response in long-term bilateral subthalamic stimulation for Parkinson's disease.
Subthalamic nucleus deep brain stimulation (STN-DBS) is effective in advanced Parkinson's disease (PD), but its effects on the levodopa response are unclear. We studied the levodopa response after long-term STN-DBS, STN-DBS efficacy and predictive value of preoperative levodopa response to long-term DBS benefit in 33 PD patients with bilateral STN-DBS. Patients were assessed using the Unified Parkinson's Disease Rating Scale preoperatively (with and without medications) and postoperatively (without medications or stimulation, with only medications or stimulation, and with both medications and stimulation). Levodopa response significantly decreased postoperatively by 31.1% at 3 years and 32.3% at 5 years, possibly related to the reduction in medication requirement, direct STN stimulation effect or PD progression. STN-DBS alone significantly improved motor scores (37.2% at 3 years and 35.1% at 5 years) and activities of daily living scores (27.1% at 3 years and 19.2% at 5 years). Anti-PD drugs were significantly reduced by 47.9% at 3 years and 39.8% at 5 years. However, the magnitude of the preoperative response to levodopa did not predict DBS benefit at 3 and 5 years.
Piboolnurak
Panida
P
Movement Disorders Center, Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
Lang
Anthony E
AE
Lozano
Andres M
AM
Miyasaki
Janis M
JM
Saint-Cyr
Jean A
JA
Poon
Yu-Yan W
YY
Hutchison
William D
WD
Dostrovsky
Jonathan O
JO
Moro
Elena
E
D000978:Antiparkinson Agents / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020531:Subthalamic Nucleus / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa