Determining Factors for the Reduction of Dopaminergic Drugs after Bilateral Subthalamic Nucleus Deep Brain Stimulation

J Korean Neurol Assoc > Volume 26(1); 2008 > Article

Journal of the Korean Neurological Association 2008;26(1): 8-13.

양측 시상밑핵 뇌심부자극 후 도파민성 약물 감량을 결정하는 요인

김성렬, 정선주 이태연a 김미정 김미선 이명종

울산대학교 의과대학 서울아산병원 신경과 파킨슨병센터, 보바스 기념병원 신경과

Determining Factors for the Reduction of Dopaminergic Drugs after Bilateral Subthalamic Nucleus Deep Brain Stimulation

Sung Reul Kim

Center for Parkinsonism and Other Movement Disorders, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul; Department of Neurology, Bobath Memorial Hospitala, Seongnam, Korea

Abstract

Background: We aimed to investigate the possible factors determining reduction of dopaminergic drugs in patients who received bilateral subthalamic nucleus (STN) deep brain stimulation (DBS).
Methods: We studied 33 consecutive Parkinson’s disease (PD) patients who underwent bilateral STN DBS between March 2002 and April 2006. Patients were assessed at baseline and 6 months and 1 year after surgery.
Results: The dose of dopaminergic drugs was significantly decreased by 16.5% (p<0.05) and 14.9% (p<0.05), at post op 6 months and 12 months respectively. The reduction rate of dopaminergic drugs after bilateral STN DBS was positively correlated with the dopaminergic drug dosage at baseline (p<0.05) and was negatively correlated with the scores of “off”-period UPDRS II (p<0.05), III (p<0.001), and total UPDRS (p<0.001) at baseline. The difference of UPDRS scores between “on” and “off” periods on the levodopa challenge test was negatively correlated with the reduction rate of dopaminergic drug dosage after bilateral STN DBS (p<0.001).
Conclusions: It is likely that the main determining factors for the reduction of dopaminergic drug dosages after bilateral STN DBS in advanced PD are the UPDRS III score during “off” periods, difference of the UPDRS III score between “on” and “off” periods on the levodopa challenge test and dose of dopaminergic drugs at baseline.KeyWords:Deep brain stimulation, Parkinson’s disease, Dopaminergic drugs