title: Influence of deep brain stimulation and levodopa on sensory signs in Parkinson's disease.
abstract: To examine the effects of levodopa (L-dopa) and deep brain stimulation of the subthalamic nucleus (STN-DBS) on sensory symptoms and signs in Parkinson's disease (PD). Seventeen patients with PD were included. (1) Presence of sensory symptoms and (2) effects of L-dopa and STN-DBS on sensory symptoms and signs [assessed by quantitative sensory testing (QST)] were examined 6 months after starting STN-DBS. In addition, in 12 of these patients, presence of sensory symptoms prior and post STN-DBS was compared. Pain was most frequently nociceptive. In about 30-40%, pain and sensory symptoms were associated with PD motor symptoms. In most of these cases, pain responded to L-dopa. Intensity of pain was reduced post STN-DBS compared to pre STN-DBS. L-Dopa had no influence on detection thresholds, whereas STN-DBS improved thermal detection thresholds. However, thermal and mechanical pain thresholds were uninfluenced by L-dopa or STN-DBS. Although some patients reported an improvement of pain with STN-DBS or L-dopa, objectively pain sensitivity as assessed by QST was not altered by STN-DBS or L-dopa suggesting that there is no evidence for a direct modulation of central pain processing by L-dopa or STN-DBS.
authors.affiliation: Department of Neurology, Division of Neurological Pain Research and Therapy, Universitätsklinikum Schleswig-Holstein, Kiel, Germany. j.ludwig@neurologie.uni-kiel.de
authors.forename: Janne
authors.initials: J
authors.lastname: Gierthmühlen
authors.forename: Philipp
authors.initials: P
authors.lastname: Arning
authors.forename: Andreas
authors.initials: A
authors.lastname: Binder
authors.forename: Jan
authors.initials: J
authors.lastname: Herzog
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.forename: Gunnar
authors.initials: G
authors.lastname: Wasner
authors.forename: Ralf
authors.initials: R
authors.lastname: Baron
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy; D012678:Sensation Disorders / Q000209:etiology / Q000628:therapy*; D012684:Sensory Thresholds / Q000187:drug effects / Q000502:physiology; D018709:Statistics, Nonparametric; D020531:Subthalamic Nucleus / Q000502:physiology; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa