l -Dopa-induced dyskinesia improvement after STN-DBS depends upon medication reduction

Abstract

The authors studied the long-term evolution of levodopa-induced dyskinesia (LID) after levodopa challenge in two groups of six STN-deep brain stimulation-treated Parkinson disease (PD) patients, one requiring medication after surgery and the other not. A dramatic (96%) reduction of LID severity was obtained in the six postoperatively untreated patients compared to a moderate improvement (47%) in the treated group (p < 0.03). These data support dopaminergic stimulation and striatal desensitization as major determinants of LID in PD.

High-Frequency Stimulation of the Subthalamic Nucleus Potentiates l-DOPA-Induced Neurochemical Changes in the Striatum in a Rat Model of Parkinson's Disease

“…This increasing effect is, however, moderate, mostly observable at the end of the monitoring period of 2 h after L-DOPA injection. This finding argues against a direct antidyskinetic effect of STN-HFS and supports the view that relief of LID by HFS of STN depends on postoperative reduction of dopaminergic medication (Krack et al, 2002;Follett, 2004;Russmann et al, 2004). In contrast with its weak impact on LID, STN-HFS significantly interferes with the cellular effects of both associated and previous L-DOPA treatment at striatal level.…”

Direct Relief of Levodopa-Induced Dyskinesia by Stimulation in the Area Above the Subthalamic Nucleus in a Patient With Parkinson's Disease -Case Report-

“…3,7,15) In contrast, DBS of the globus pallidus internus (GPi) has a direct antidyskinetic effect. 16) GPi-DBS yields significant improvement of LD-induced dyskinesia after surgery without reduction of LD dosage.…”

Targeting the Subthalamic Nucleus for Deep Brain Stimulation in Parkinson Disease: The Impact of High Field Strength MRI

“…The medication doses could be reduced to the same extent in both groups and were in the range reported in the literature (Beric et al, 2001;Limousin et al, 1998;Minguez-Castellanos et al, 2005;Okun et al, 2005;Russmann et al, 2004). Differences in preoperative image acquisition (1.5 T, 3 T), postprocessing and defined target coordinates and chosen electrode tracks were not associated with a definite improvement of motor response and drug reduction, which would justify the use of 3 T MRI absolutely.…”