title: The medical treatment of patients with Parkinson's disease receiving subthalamic neurostimulation.
abstract: BACKGROUND
  Deep brain stimulation of subthalamic nucleus (STN-DBS) for Parkinson's disease allows for a reduction in medication dosage. Changes in total levodopa equivalent daily dose (LEDD) have been frequently reported, there is little information about changes within the drug classes.
  
  
  METHODS
  We retrospectively assessed the changes in antiparkinsonian drugs dosages in 150 patients from one center who had preoperative and postoperative evaluations at 6 months and 3 years. Two long term subgroups with postoperative follow-up till the 5th-6th year (n = 58) and 10th year (n = 15) were included.
  
  
  RESULTS
  The major modifications in medication dosage occurred during the initial postoperative period. LEDD was reduced by 53.4% compared to baseline at 6 months and 47.9% at 3 years. Fifty six percent and 41.3% of the patients were on monotherapy, 9.3% on no medication at 6 months and 6.7% at 3 years post surgery. Patients on levodopa, or dopamine agonists showed similar reductions. At the 3rd year the oldest group of patients showed a significant decrease in dopamine agonists. The number of patients treated with amantadine was significantly reduced; however the number of patients treated with antidepressants was significantly increased over the first 3 years. Annual medication costs per patient were decreased after the DBS-STN implantation by 61.3% at 6 months and 55.4% at 3 years.
  
  
  CONCLUSIONS
  STN-DBS allows for a reduction in the dosage of medication and the costs are similarly reduced. In this cohort different medication groups were reduced to a similar extent. Patients' demographic factors did not play a major role in the selection of treatment.
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Alexoudi
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Shalash
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany.
authors.forename: Karina
authors.initials: K
authors.lastname: Knudsen
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Witt
authors.affiliation: Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Mehdorn
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany. Electronic address: g.deuschl@neurologie.uni-kiel.de.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D007980:Levodopa
keywords: Medication; Medication costs; Neurostimulation; Parkinson's disease; Subthalamic nucleus