Management of antiparkinsonian therapy during chronic subthalamic stimulation in Parkinson's disease.
OBJECTIVE
This article reports the detailed analysis of antiparkinsonian drug therapy in 78 consecutive Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) of the subthalamic nucleus (STN).


METHODS
The amount and type of antiparkinsonian drugs--including L-dopa, dopamine receptor agonists, associated drugs such as catechol-O-methyl transferase and monoamine oxidase inhibitors, amantadine and anticholinergics--were quantified before surgery and at two control visits 1 and 3 years following chronic STN stimulation.


RESULTS
The L-dopa mean daily dose was reduced by approximately 60% after 1 year and remained stable after 3 years. Apomorphine, bromocriptine, tolcapone and selegiline were withdrawn after STN-DBS. Three years postoperatively, 9 patients (11.5%) no longer required L-dopa and 6 patients (7.7%) completely stopped all dopaminergic medications. More patients were on monotherapy with either L-dopa or dopamine receptor agonist, and fewer patients required combined treatment of dopamine receptor agonist and L-dopa compared with the pre-surgical condition.


CONCLUSIONS
Dopaminergic drug treatment is persistently reduced and simplified following chronic STN-DBS for up to 3 years.
Zibetti
M
M
Department of Neuroscience, University of Turin, via Cherasco 15, 10126 Turin, Italy. mzibetti@molinette.piemonte.it
Cinquepalmi
A
A
Angrisano
S
S
Lanotte
M
M
Lopiano
L
L
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D046690:Deep Brain Stimulation / Q000379:methods; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000502:physiology*; D013997:Time Factors
D000978:Antiparkinson Agents