title: Reduced levodopa-induced complications after 5 years of subthalamic stimulation in Parkinson's disease: a second honeymoon.
abstract: The purpose of this paper is to describe the effect of 5 years of subthalamic nucleus deep brain stimulation (STN DBS) on levodopa-induced complications, both in everyday life and during an acute challenge with levodopa. Thirty three patients were evaluated during an acute levodopa challenge before surgery and then 1 and 5 years afterwards (both off stim and on stim), using the UPDRS III scale and the CAPSIT-PD scales for dystonia and peak-dose dyskinesia. The UPDRS IV scale was used to assess motor complications in everyday life. The levodopa daily dose and DBS parameters were also recorded. Levodopa-induced complications in everyday life (UPDRS IV) and during an acute levodopa challenge had improved markedly after 1 year (both on and off stim) and still further at 5 years. Peak-dose dyskinesia decreased between the 1- and 5-year measurements. STN DBS decreases levodopa-induced motor complications over the long term. This phenomenon may be explained by (a) overall stabilization of the basal ganglia network and (b) striatal synaptic changes. Our results suggest that DBS leads to both qualitative and quantitative modulations in the corticostriatal loops.
authors.affiliation: Department of Neurology and Movement Disorders, Salengro Hospital, EA 2683, Lille University Medical Center, Lille, France. c-simonin@chru-lille.fr
authors.forename: Clemence
authors.initials: C
authors.lastname: Simonin
authors.forename: M
authors.initials: M
authors.lastname: Tir
authors.forename: D
authors.initials: D
authors.lastname: Devos
authors.forename: A
authors.initials: A
authors.lastname: Kreisler
authors.forename: K
authors.initials: K
authors.lastname: Dujardin
authors.forename: J
authors.initials: J
authors.lastname: Salleron
authors.forename: A
authors.initials: A
authors.lastname: Delval
authors.forename: S
authors.initials: S
authors.lastname: Blond
authors.forename: L
authors.initials: L
authors.lastname: Defebvre
authors.forename: A
authors.initials: A
authors.lastname: Destée
authors.forename: P
authors.initials: P
authors.lastname: Krystkowiak
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D046690:Deep Brain Stimulation; D004409:Dyskinesia, Drug-Induced / Q000628:therapy; D004421:Dystonia / Q000139:chemically induced / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000009:adverse effects* / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy* / Q000628:therapy*; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa