Efficacy of subthalamic deep brain stimulation for levodopa-induced dyskinesia in patients with Parkinson's disease: retrospective analysis of 12 cases

Abstract

Objective To evaluate the clinical effectiveness of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in treatment of levodopa-induced dyskinesia (LID) in patients with Parkinson's disease (PD), and to explore the feasibility and the possible underlying mechanism of the treatment. Methods A retrospective review was conducted on all the PD patients who underwent STN-DBS in our department from March 2016 to December 2019. Unified Parkinson's Disease Rating Scale (UPDRS) part Ⅲ and part Ⅳ, dyskinesia subscore (items 32 to 34 of UPDRS part Ⅳ) and the levodopa equivalent daily dose (LEDD), which were used to evaluate the improvement of the symptoms before and in 6 months after operation. Results In 6 months after STN-DBS, the LID symptoms of the 12 patients finally enrolled were significantly improved, with the improvement rates of UPDRS Ⅳ score and dyskinesia subscore of (45.91±13.01)% and (61.96±22.03)%, respectively. Among them, the LEDD was maintained in 2 patients, and reduced in the other 10 patients, with the averagely reduced rate of 43.58%, and the highest rate of 72.00%. Meanwhile, the motor symptoms of all patients were also significantly improved, and the improvement rate of UPDRS Ⅲ score was (68.14±9.51)%. Conclusion STN-DBS significantly improves dyskinesia symptom of PD patients. Its anti-dyskinesia effect may be not only related to reduction of drug dose, but also to direct inhibition of LID.

Keywords

• parkinson's disease
• deep brain stimulation
• levodopa-induced dyskinesia
• subthalamic nucleus
• levodopa equivalent daily dose