Objective: In this study, we planned to research the effect of preoperative levodopa response to postoperative levodopa response and clinical outcome.

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a safe and successful treatment in advanced Parkinson’s disease (PD). However, the effects of DBS of the STN on the postoperative levodopa response are unclear.

Method: Forty-nine (29 men and 20 women)  PD patients undergoing bilateral DBS of the STN were included in this study. Data were obtained from all patients for the analysis a year follow-up. Their clinical motor symptoms were assessed preoperatively by UPDRS Part III score in both OFF (at least 12 h after the last levodopa dose) and ON (1.5 times the optimal morning dose of levodopa) medication states. Preoperatively and postoperatively, the percentage difference between these two scores was evaluated as levodopa response.  Postoperatively, the assessments were obtained in three consecutive conditions (off-medications/ off-stimulation, off-medications/on-stimulation, on medications/on-stimulation).

Results: Mean age was 54.6 ± 9 years (a range of 27–70 years).  Levodopa response significantly decreased postoperatively by 32 % a year, possibly related to the reduction in medication requirement, direct STN stimulation effect or PD progression. Compared with preoperative med on and postoperative stim on / med on scores, the clinical results of the first year were obtained and an improvement of 20% on the UPDRS 3 score was observed. Compared with preoperative levodopa response and clinical outcomes, better clinical results were obtained in patients with higher preoperative levodopa response (P <0.05).

Conclusion: In this study, we confirm that the response of L-dopa decreases after DBS of the STN. The reasons for this finding are not clear. However, DBS of the STN allows for the reduction of PD medications and improvement of daily life activities, motor function, motor fluctuations, and dyskinesia. Although the benefit from medication has decreased over time, the benefit of DBS for stim on med on scores remains prominent in the first year.  Also, the preoperative L-dopa response predicted the improvement from DBS at a year following surgery. As a result, the response to levodopa is useful in demonstrating efficacy in the first year of STN DBS, although it decreases in the postoperative period.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-deep-brain-stimulation-of-the-subthalamic-nucleus-on-the-postoperative-levodopa-response-one-year-follow-up/