Objective: To evaluate the decrease in Dopaminergic drug dosage and increase in ON time following Bilateral STN DBS using constant current for Advanced PD

Background: One of the significant advantages of Bilateral Subthalamic Nucleus DBS for Advanced Parkinsons Disease is significant decrease in dopaminergic drug dosage. The more the decrease in dopaminergic drugs following DBS, the more weapons left in hand for the future in the form of drugs and current.

A standard protocol is putting the patient back on all pre-operative drugs immediately following surgery and then modifying the drug regimen slowly with time after switching the pacemaker on a couple of weeks post-operatively.

Methods: The author has been following a different protocol over the last six years of his practice. The author has been using constant current technology. Patients undergo pacemaker programming from the second post-operative day and are slowly programmed to non-dyskinetic levels. The patient is kept in hospital for around 7 days for further programming under observation.                         

If they are able to walk normally without dopaminergic medications, their dopaminergic medications are no longer re-introduced. Most patients improve in tremor and rigidity following pacemaker programming but are unable to walk normally. They are first started on Pramipexole (average of 1.5 mg/day) which generally gets them walking in most cases. If Pramipexole alone fails which is quite rare, Levodopa is restarted at an average of 300 mg/day.

Results: Using such a treatment paradigm, 80% of the author’s patients over the last six years have come completely off Levodopa. The rest 20% have 70-80% decrease in dopaminergic drug dosage. An added benefit of switching off Levodopa is complete disappearance of dyskinesias. The other benefit of switching off Levodopa is a smoother ON with almost complete disappearance of ON-OFF. All the author’s patients over the last six years are ON 24 hours a day without significant Dyskinesias.

Conclusions: Pacemaker programming and medical adjustment are crucial to success of DBS. Significant decrease in dopaminergic drugs can be achieved with proper surgery, skillful pacemaker programming and restarting/restricting medications from/to the bare minimum.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/maximising-decrease-in-dopaminergic-drugs-and-increase-in-on-time-following-bilateral-stn-dbs-using-constant-current-for-advanced-parkinsons-disease/