Objective: A retrospective analysis of the rate of dopaminergic drugs reduction following subthalamic nucleus Deep Brain Stimulation (STN-DBS) in a group of Parkinson’s disease patients and their surgical outcome over three years.

Background: Whilst it is well established that the motor complications of PD are significantly improved by STN-DBS, allowing for dopaminergic drug reduction, the extent of such reduction varies considerably amongst centres around the world. It is not clear whether the surgical outcome is affected by the dopaminergic reduction rate.

Methods: The records of 38 patients who underwent bilateral STN-DBS at our centre, between 2011 and 2015, were analysed. The LEDD reduction was established. The surgical outcome as measured by improvement on UPDRS III and effect on anxiety, depression (HADS) and quality of life (PDQ-39) were studied.

Results: The mean Levodopa Equivalent Daily Dose (LEDD) was reduced by 16.9% at 6 months postoperatively, 21% at 12 months and 27.7 % at three years. The UPDRS III off medications improved by 13 points at 6 months, 12.5 at 12 months and 9 at 3 years. There was a statistically significant improvement in the PDQ-39 scores at 6 months, 12 months and 2 years. There was no statistically significant change in the anxiety and depression scores, at 6,12, 24 or 36 months.

Conclusions: Our study has demonstrated that the negative effect of postoperative dopaminergic drug reduction on non-motor features of PD (such as depression and apathy), as previously reported, may be mitigated by a less aggressive approach. This will potentially improve patients’ overall satisfaction and quality of life.

References: Alexoudi A, Shalash A, Knudsen K, Witt K, Mehdorn M, Volkmann J, Deuschl G. The medical treatment of patients with Parkinson’s disease receiving subthalamic neurostimulation. Parkinsonism Relat Disord. 2015;21(6):555-60. Zibetti M, Pesare M, Cinquepalmi A, Rosso M, Bergamasco B, Ducati A, Lanotte M, Lopiano L. Antiparkinsonian therapy modifications in PD patients after STN DBS: a retrospective observational analysis. Parkinsonism Relat Disord. 2008;14(8):608-12.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/could-the-rate-of-dopaminergic-medications-reduction-affect-outcome-after-stn-dbs/