Medical Management of Parkinson's Disease after Initiation of Deep Brain Stimulation.
In this review, we have gathered all the available evidence to guide medication management after deep brain stimulation (DBS) in Parkinson's disease (PD). Surprisingly, we found that almost no study addressed drug-based management in the postoperative period. Dopaminergic medications are usually reduced, but whether the levodopa or dopamine agonist is to be reduced is left to the personal preference of the treating physician. We have summarized the pros and cons of both approaches. No study on the management of cognitive problems after DBS has been done, and only a few studies have explored the pharmacological management of such DBS-resistant symptoms as voice (amantadine), balance (donepezil) or gait disorders (amantadine, methylphenidate). As for the psychiatric problems so frequently reported in PD patients, researchers have directed their attention to the complex interplay between stimulation and reduction of dopaminergic drugs only recently. In conclusion, studies addressing medical management following DBS are still needed and will certainly contribute to the ultimate success of DBS procedures.
1Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,and Division of Neurology,University Health Network,University of Toronto,Toronto,Ontario,Canada.
Alfonso
A
Fasano
3Pacific Parkinson's Research Centre,Djavad Mowafaghian Centre for Brain Health,University of British Columbia,Vancouver,British Columbia,Canada.
Silke
S
Appel-Cresswell
4Clinical Neurological Sciences,Movement Disorders Centre,Lawson Health Research Institute and Western University,London,Ontario,Canada.
Mandar
M
Jog
5Department of Psychiatry,University of Toronto,Toronto,Ontario,Canada.
Mateusz
M
Zurowkski
6Division of Neurology,Toronto Western Hospital,University Health Network,Toronto,Ontario,Canada.
Sarah
S
Duff-Canning
6Division of Neurology,Toronto Western Hospital,University Health Network,Toronto,Ontario,Canada.
Melanie
M
Cohn
8Department of Medicine and Surgery,Centre for Neurodegenerative Diseases,University of Salerno,Salerno,Italy.
Marina
M
Picillo
9Division of Neurosurgery,University of British Columbia,Vancouver,British Columbia,Canada.
Christopher R
CR
Honey
1Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,and Division of Neurology,University Health Network,University of Toronto,Toronto,Ontario,Canada.
Michel
M
Panisset
1Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,and Division of Neurology,University Health Network,University of Toronto,Toronto,Ontario,Canada.
Renato Puppi
RP
Munhoz
D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology; D046690:Deep Brain Stimulation / Q000379:methods*; D019468:Disease Management; D006801:Humans; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*
D000978:Antiparkinson Agents
Deep brain stimulation; Globus pallidus internus; Medication; Parkinson’s disease; Subthalamic nucleus