title: The Impact of Pallidal and Subthalamic Deep Brain Stimulation on Urologic Function in Parkinson's Disease.
abstract: OBJECTIVE
  Deep Brain Stimulation (DBS) is an established adjunctive surgical intervention for treating Parkinson's disease (PD) motor symptoms. Both surgical targets, the globus pallidus interna (GPi) and subthalamic nucleus (STN), appear equally beneficial when treating motor symptoms but effects on nonmotor symptoms are not clear. Lower urinary tract symptoms (LUTS) are a common PD complaint. Given prior data in STN-DBS, we aimed to further explore potential benefits in LUTS in both targets.
  
  
  METHODS
  We performed a prospective, nonblinded clinical trial evaluating LUTS in PD patients in both targets pre and post DBS using validated urologic surveys. Participants were already slated for DBS and target selection predetermined before study entry. LUTS was evaluated using: the American Urological Association (AUA-SI), Quality of Life score (QOL), Overactive Bladder 8 Questionnaire (OAB-q), and Sexual Health Inventory for Men (SHIM).
  
  
  RESULTS
  Of 33 participants, 20 underwent STN DBS and 13 had GPi DBS. Patients demonstrated moderate baseline LUTS. The urologic QOL score significantly improved post DBS (3.24 ± 1.77vs. 2.52 ± 1.30; p = 0.03). Analyzed by target, only the STN showed significant change in QOL (3.20 ± 1.61 vs 2.25 ± 1.33; p = 0.04). There were no other significant differences in urologic scores post DBS noted in either target.
  
  
  CONCLUSIONS
  In PD patients with moderate LUTS, there were notable improvements in QOL for LUTS post DBS in the total sample and STN target. There may be differences in DBS effects on LUTS between targets but this will require further larger, blinded studies.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mock
authors.affiliation: Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Osborn
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Brown
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: W
authors.initials: W
authors.lastname: Stuart Reynolds
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Turchan
authors.affiliation: Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA.
authors.forename: Srivatsan
authors.initials: S
authors.lastname: Pallavaram
authors.affiliation: Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA.
authors.forename: William
authors.initials: W
authors.lastname: Rodriguez
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Dmochowski
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA. christopher.tolleson@vanderbilt.edu.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Tolleson
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000628:therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000209:etiology* / Q000628:therapy*
keywords: Bladder dysfunction; Parkinson's disease; deep brain stimulation; globus pallidus interna; pallidal stimulation; subthalamic nucleus