title: Anti-cholinergics for axial symptoms in Parkinson's disease after subthalamic stimulation.
abstract: OBJECTIVE
  We studied the effect of anti-cholinergic therapy on axial symptoms that show a tendency to worsen over time after deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD).
  
  
  METHODS
  We conducted a prospective study of 20 consecutive patients treated with the anti-cholinergic agent trihexyphenidyl after bilateral STN-DBS and assessed the effect of anti-cholinergic therapy on parkinsonism 1 month after its initiation using the Unified Parkinson's Disease Rating Scale (UPDRS).
  
  
  RESULTS
  After a mean post-operative follow-up period of 22.3 months, the scores of axial symptoms on UPDRS part II (ADL score) and part III (motor score) deteriorated by 87% and 54% (baseline), respectively, compared with the pre-operative scores (P < 0.001 for both comparisons). After adding trihexyphenidyl to dopaminergic medication with stimulation, the scores of axial symptoms on UPDRS part II and part III improved from baseline by 33% and 39%, respectively (P < 0.001 for both comparisons).
  
  
  CONCLUSIONS
  Our findings demonstrated that the anti-cholinergic agent trihexyphenidyl shows positive effect for a patient population developing deterioration of axial symptoms after STN-DBS. The results in the present study may provide insights into the mechanism of emergence or progression of axial symptoms in patients with PD after STN-DBS.
authors.affiliation: Department of Speech and Hearing Sciences, International University of Health and Welfare School of Rehabilitation, Fukuoka, Japan. yasubaba@iuhw.ac.jp
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Baba
authors.forename: Masa-Aki
authors.initials: MA
authors.lastname: Higuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Abe
authors.forename: Kouzou
authors.initials: K
authors.lastname: Fukuyama
authors.forename: Rieko
authors.initials: R
authors.lastname: Onozawa
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Uehara
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yamada
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000628:therapy; D011446:Prospective Studies; D020531:Subthalamic Nucleus; D016896:Treatment Outcome; D014282:Trihexyphenidyl / Q000627:therapeutic use*
chemical_list: D018680:Cholinergic Antagonists; D014282:Trihexyphenidyl