The Impact of Pallidal and Subthalamic Deep Brain Stimulation on Urologic Function in Parkinson’s Disease

Abstract

Objective Deep Brain Stimulation (DBS) is an established adjunctive surgical intervention for treating Parkinson’s disease (PD) motor symptoms. Both surgical targets, the globus pallidus interna (GPi) and subthalamic nucleus (STN), appear equally beneficial when treating motor symptoms but effects on nonmotor symptoms are not clear. Lower urinary tract symptoms (LUTS) are a common PD complaint. Given prior data in STN-DBS, we aimed to further explore potential benefits in LUTS in both targets. Methods We performed a prospective, non-blinded clinical trial evaluating LUTS in PD patients in both targets pre and post DBS using validated urologic surveys. Participants were already slated for DBS and target selection predetermined before study entry. LUTS was evaluated using: the American Urological Association (AUA-SI), Quality of Life score (QOL), Overactive bladder 8 questionnaire (OAB-q), and sexual health inventory for men (SHIM). Results Of 33 participants, 20 underwent STN DBS and 13 had GPi DBS. Patients demonstrated moderate baseline LUTS. The urologic QOL score significantly improved post DBS (3.24±1.77vs 2.52±1.30; p=0.03). Analyzed by target, only the STN showed significant change in QOL (vs. 2.25±1.33; p=0.04). There were no other significant differences in urologic scores post DBS noted in either target. Conclusion In PD patients with moderate LUTS, there were notable improvements in QOL for LUTS post DBS in the total sample and STN target. There may be differences in DBS effects on LUTS between targets but this will require further larger, blinded studies.

Clinical Impact of Deep Brain Stimulation on the Autonomic System in Patients with Parkinson's Disease

“…Both of these structures transfer striatal information to downstream thalamic nuclei, namely, the ventral anterior and ventral lateral nuclei, and from there to the frontal cortex, supplementary motor area, and dorsolateral prefrontal cortex. 20 Although STN-DBS has been shown to have positive benefits by improving abnormal urodynamic parameters in PD patients with lower urinary tract symptoms, 21 there have been cases in the literature where stimulation has resulted in significant urinary dysfunction. Fritsche and colleagues 22 reported 2 patients who developed acute urinary retention following STN-DBS, most likely attributed to suboptimal positioning of the electrodes.…”

“…A further study by Mock and colleagues 21 analyzed the lower urinary tract symptoms in PD patients undergoing STN (n = 20) and GPi (n = 13) DBS. They found that urologic quality of life scores improved overall following DBS.…”

Management of neurogenic bladder in patients with Parkinson's disease: A systematic review

“…The studies by Herzog and Seif in relation to subthalamic stimulation were prospective before/after and Porter conducted a clinical trial in the field of thalamotomy. Mock, Roy, and Witte conducted a studies in the field of Deep Brain Stimulation (DBS). The first was prospective before‐after, the second was prospective non‐blinded clinical trial and the third was randomized clinical trial.…”

Management of Autonomic Dysfunction in Parkinson's Disease

“…114,115 Improvement in lower urinary tract symptoms in PD patients has also been documented following deep brain stimulation surgery targeting the subthalamic nucleus. 116…”