Yonsei Med J.  2015 Sep;56(5):1316-1321. 10.3349/ymj.2015.56.5.1316.

Effect of Subthalamic Deep Brain Stimulation on Levodopa-Induced Dyskinesia in Parkinson's Disease

• Kim JH
• Chang WS
• Jung HH
• Chang JW

• KMID: 2163623
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1316

Abstract

PURPOSE
To evaluate the effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on levodopa-induced peakdose dyskinesia in patients with Parkinson's disease (PD).
MATERIALS AND METHODS
A retrospective review was conducted on patients who underwent STN DBS for PD from May 2000 to July 2012. Only patients with levodopa-induced dyskinesia prior to surgery and more than 1 year of available follow-up data after DBS were included. The outcome measures included the dyskinesia subscore of the Unified Parkinson's Disease Rating Scale (UPDRS) part IV (items 32 to 34 of UPDRS part IV) and the levodopa equivalent daily dose (LEDD). The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients. Group 2 was further divided by the location of DBS leads.
RESULTS
Of the 100 patients enrolled, 67 were in Group 1, while those remaining were in Group 2. Twelve months after STN DBS, Groups 1 and 2 showed improvements of 61.90% and 57.14%, respectively, in the dyskinesia subscore. Group 1 was more likely to experience dyskinesia suppression; however, the association between the groups and dyskinesia suppression was not statistically significant (p=0.619). In Group 2, dyskinesia was significantly decreased by stimulation of the area above the STN in 18 patients compared to stimulation of the STN in 15 patients (p=0.048).
CONCLUSION
Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

Keyword

Deep brain stimulation; dyskinesias; Parkinson disease; subthalamic nucleus

MeSH Terms

Aged
Aged, 80 and over
Antiparkinson Agents/administration & dosage/*adverse effects
*Deep Brain Stimulation
Dyskinesia, Drug-Induced/*therapy
Female
Humans
Levodopa/administration & dosage/*adverse effects
Male
Middle Aged
Outcome Assessment (Health Care)
Parkinson Disease/*drug therapy
Postoperative Period
Retrospective Studies
Subthalamic Nucleus
Treatment Outcome
Antiparkinson Agents
Levodopa

Figure

• 

  Fig. 1 Schematic illustration of the electrode insertion site as described in Hamani, et al.36 The 0 and 1 contacts were located in the STN, whereas the 2 and 3 contacts were located in the area above the STN including the zona incerta. AL, ansa lenticularis; CP, cerebral peduncle; FF, Field of Forel; GPe, globus pallidus externus; GPi, globus pallidus internus; H1, H1 Field of Forel (thalamic fasciculus); IC, internal capsule; LF, lenticular fasciculus (H2); PPN, pedunculopontine nucleus; Put, putamen; SN, substantia nigra; STN, subthalamic nucleus; Thal, thalamus; ZI, zona incerta.

• 

  Fig. 2 The mean improvement of dyskinesia was reduced by 73.57% (from 3.44 preoperatively to 0.83 postoperatively) in patients with stimulation of the area above the STN, whereas the mean improvement of dyskinesia was reduced by only 37.44% (from 5.40 preoperatively to 3.07 postoperatively) in patients where the STN was directly stimulated. There was a significant difference between stimulation of the area above the STN and within the STN. STN, subthalamic nucleus.

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