Annals of Movement Disorders (Apr 2024)

The impact of bilateral subthalamic nucleus deep brain stimulation on dyskinesia and levodopa equivalent daily dose in advanced Parkinson’s disease

  • Aniket S. Phutane,
  • Rajesh Alugolu,
  • Rukmini Kandadai,
  • Vijaya Saradhi Mudumba,
  • Rupam Borgohain,
  • Syed Tazeem Fathima,
  • Sai Sri Lakshmi Meka

DOI
https://doi.org/10.4103/aomd.aomd_9_23
Journal volume & issue
Vol. 7, no. 1
pp. 19 – 24

Abstract

Read online

OBJECTIVE: To assess the effect of bilateral subthalamic nucleus deep brain stimulation (B/L STN DBS) on the progression of dyskinesia and the levodopa equivalent daily dose (LEDD) in advanced Parkinson’s disease (APD) patients 6 months postoperatively. METHODS: Seventeen APD patients aged 21–80 years with the minimum modified Hoen & Yahr score of 2 while off medication and poor motor function underwent B/L STN DBS from January 2021 to December 2021. They were assessed preoperatively and 6 months postoperatively using the Unified dyskinesia rating scale (UDysRS) and Unified Parkinson’s Disease Rating Scale Part IV (UPDRS IV) for dyskinesia and LEDD dosage. RESULTS: Significant improvement was observed postoperatively in both UDysRS (pre-op 66.53 ± 24.59, post-op 30.88 ± 12.01; P = 0.000) and UPDRS IV (pre-op 9.24 ± 1.75, post-op 5.76 ± 1.39; P = 0.000) scores. The overall clinical improvement using UDysRS was 52.23 ± 16.23%. Each subscale of UDysRS showed significant improvement postoperatively: ON dyskinesia (pre-op 21 ± 7.7, post-op 13.76 ± 5.79; P < 0.05); OFF dystonia (pre-op 8.53 ± 3.26, post-op 4.94 ± 2.70; P < 0.05); impairment (face, pre-op 2.47 ± 2.52, post-op 0.29 ± 0.98, P < 0.05; neck and trunk, pre-op 6.29 ± 4.55, post-op 0.59 ± 0.87, P < 0.05; arms, pre-op 13.06 ± 5.86, post-op 5.76 ± 3.7, P < 0.05; and legs, pre-op 7.18 ± 5.12, post-op 1.29 ± 1.57, P < 0.05); and disability (pre-op 8 ± 3.46, post-op 4.24 ± 2.25; P < 0.05), suggesting high clinical significance. LEDD (pre-op 673.41 ± 212.69 mg, post-op 386.82 ± 133.01 mg; P = 0.000) showed significant reduction in dosage 6 months postoperatively. LEDD reduction and dyskinesia improvement showed mild-to-moderate positive correlation (r = 0.404). CONCLUSION: B/L STN DBS helps in improving dyskinesia by reducing LEDD in APD patients.

Keywords