Margherita Fabbri1, Miguel Coelho2, Leonor Correia Guedes2, Mario M Rosa3, Daisy Abreu1, Nilza Gonçalves1, Angelo Antonini4, Joaquim J Ferreira5. 1. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal. 2. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal. 3. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal. 4. Fondazione Ospedale San Camillo"-I.R.C.C.S., Parkinson and Movement Disorders Unit, Venice, Italy; Department of Neurosciences (DNS), Padova University, Padova, Italy. 5. Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal; Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal. Electronic address: joaquimjferreira@gmail.com.
Abstract
BACKGROUND: Subthalamic deep brain stimulation (STN-DBS) is an established treatment for the motor complications of Parkinson's disease (PD) and may have beneficial effects on non-motor symptoms (NMS). However, the acute effect of STN stimulation on NMS has only been explored in small PD cohorts with short post-surgical follow-up. OBJECTIVE: To study NMS response to an acute stimulation challenge in an STN-DBS PD population with a medium/long-term post-surgical follow-up. METHODS: 32 STN-DBS PD patients were tested twice (MED OFF/STIM OFF and MED OFF/STIM ON). MDS-UPDRS-III, blood pressure (BP) assessment, a visual analogue scale for pain and fatigue and State Trait Anxiety Scale score were evaluated during both stimulation conditions. NMS were assessed with MDS-UPDRS-I, Non-Motor Symptoms Scale, Geriatric Depression Scale and the Neuropsychiatric Inventory scale. RESULTS: Mean (SD) age was 62.5 (±13.3) years, mean disease duration 18.7 (±5.1) years, mean post-surgical follow-up 4.6 (±1.3) years, and the mean reduction of levodopa equivalent daily dose after surgery was 58.9% (±25.4%). Mean (SD) motor response to stimulation was 40% (15%). STN stimulation significantly improved anxiety (mean 18% ± 19%, P < 0.005) and fatigue (mean 25% ± 51%; P < 0.05), while pain, although improved did not reach statistical significance. With stimulation ON, BP significantly decreased during orthostatism (P < 0.05) and there was a significant increase in asymptomatic orthostatic hypotension (P < 0.05). CONCLUSIONS: Acute STN stimulation improves anxiety and fatigue but decreases orthostatic BP in PD, several years after surgery. These effects should be considered when assessing long-term effect of DBS.
BACKGROUND: Subthalamic deep brain stimulation (STN-DBS) is an established treatment for the motor complications of Parkinson's disease (PD) and may have beneficial effects on non-motor symptoms (NMS). However, the acute effect of STN stimulation on NMS has only been explored in small PD cohorts with short post-surgical follow-up. OBJECTIVE: To study NMS response to an acute stimulation challenge in an STN-DBSPD population with a medium/long-term post-surgical follow-up. METHODS: 32 STN-DBSPDpatients were tested twice (MED OFF/STIM OFF and MED OFF/STIM ON). MDS-UPDRS-III, blood pressure (BP) assessment, a visual analogue scale for pain and fatigue and State Trait Anxiety Scale score were evaluated during both stimulation conditions. NMS were assessed with MDS-UPDRS-I, Non-Motor Symptoms Scale, Geriatric Depression Scale and the Neuropsychiatric Inventory scale. RESULTS: Mean (SD) age was 62.5 (±13.3) years, mean disease duration 18.7 (±5.1) years, mean post-surgical follow-up 4.6 (±1.3) years, and the mean reduction of levodopa equivalent daily dose after surgery was 58.9% (±25.4%). Mean (SD) motor response to stimulation was 40% (15%). STN stimulation significantly improved anxiety (mean 18% ± 19%, P < 0.005) and fatigue (mean 25% ± 51%; P < 0.05), while pain, although improved did not reach statistical significance. With stimulation ON, BP significantly decreased during orthostatism (P < 0.05) and there was a significant increase in asymptomatic orthostatic hypotension (P < 0.05). CONCLUSIONS: Acute STN stimulation improves anxiety and fatigue but decreases orthostatic BP in PD, several years after surgery. These effects should be considered when assessing long-term effect of DBS.
Authors: Fernando Alonso-Frech; Carla Fernandez-Garcia; Victor Gómez-Mayordomo; Mariana H G Monje; Celia Delgado-Suarez; Clara Villanueva-Iza; Maria Jose Catalan-Alonso Journal: Front Neurol Date: 2022-01-31 Impact factor: 4.003