Effect of subthalamic deep brain stimulation on levodopa-induced dyskinesia in patients with Parkinson’s disease

Abstract

Purpose : To evaluate the effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on levodopa-induced peak dose dyskinesia in patients with Parkinson’s disease (PD).

Materials and Methods : A retrospective review of patients who underwent STN DBS for PD from May 2000 to July 2012 was conducted. 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 (item 32 to 34 of UPDRS part IV) and the levodopa equivalent daily dose (LEDD). The patients were divided into two groups based on pre- to postoperative LEDD change at 12 months after the surgery; Group 1 ？ LEDD decrease >15%, Group 2 ？ the 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 the remaining were in Group 2. Twelve months after STN DBS, Group 1 and Group 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 13 patients (p = 0.048).

Conclusion : Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.