Objective: To investigate the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on constipation and olfaction in patients with Parkinson disease (PD).

Background: STN-DBS is an effective therapy for selective motor complications of PD. There is limited evidence, based on self-rated assessments, that DBS also improves non-motor symptoms, such as constipation and hyposmia in PD. Therefore, we used objective techniques to study the effects of DBS on constipation and olfaction in PD.

Method: In this prospective study, PD patients evaluated in the DBS Clinic at Mayo Clinic Rochester between 2015-2018 were screened for constipation. Assessments, before and 3 months after DBS, included: (i) Constipation – ROME III questionnaires and daily bowel diaries for 4 weeks, (ii) Olfaction – 40-item University of Pennsylvania Smell Identification Test (UPSIT), (iii) Anxiety and depression – Hospital Anxiety and Depression Scale (HADS). The levodopa equivalent daily dose (LEDD) was calculated for PD medications. Comparisons were performed with Chi-squared and paired t-tests.

Results: Of 15 recruited patients, 5 withdrew. Ten patients (8 male, mean age 67.4 years, mean PD duration 6.5 years, mean UPDRS part III score off-medication 33.7) had a mean follow-up of 3 months post-DBS. At baseline, 8 patients met ROME III criteria for constipation vs. 2 of these patients after DBS (X2=7.2, p=0.01). Amongst the 4 patients who completed bowel diaries, the mean increase in bowel movement frequency/week (5.4±1.9 vs. 6.3±1.7, p=0.18) and consistency (2.3±0.9 vs. 3.0±0.8, p=0.39) after DBS failed to reach significance. Laxative use did not change. Mean UPSIT scores (20.0±6.6 vs. 17.5±5.7, p=0.03) worsened from severe to total hyposmia. Anxiety scores (5.8±3.2 vs. 4.8±2.7, p=0.14) and depression scores (4.9±3.0 vs. 4.8±2.9, p=0.89) were unchanged. Mean baseline LEDD was 1702.5±726.8 vs. 1419±555.9 (p=0.15) post-DBS.

Conclusion: In this small, uncontrolled study, olfaction worsened and fewer patients met Rome III criteria for constipation at 3 months after STN-DBS. These findings were neither associated with changes in bowel habits recorded by diaries, nor laxative use, PD medications, or mood. This suggests that STN-DBS may directly affect constipation and olfaction. These preliminary findings should be confirmed by a larger study with longer follow-up.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-prospective-study-of-the-effects-of-deep-brain-stimulation-on-constipation-and-olfaction-in-parkinson-disease/