ABSTRACT
AIM: Dopamine dysregulation syndrome (DDS) is a complication of the dopaminergic therapy in Parkinson's disease (PD); it is manifested as a compulsive medication use and may have negative impact on patients' social, psychological, and physical functioning. An effect of deep brain stimulation in the subthalamic nucleus (DBS STN) on DDS is not fully understood. Therefore, the degree of DDS during DBS STN in PD patients was evaluated in the study. MATERIAL AND METHODS: The main group included 15 patients with DDS symptoms in the preoperative period. The comparison group consisted of 15 patients without DDS symptoms and the control group consisted of 15 patients who did not undergo surgery. RESULTS AND CONCLUSION: The severity of motor disturbances in the surgery groups has decreased significantly (by 45%). Motor complications during DBS STN in patients with DDS have decreased by 50%; a decrease in the reduction of doses of dopaminergic preparations was noted as well.
Subject(s)
Deep Brain Stimulation , Dopamine/physiology , Parkinson Disease/physiopathology , Parkinson Disease/therapy , Subthalamic Nucleus/physiopathology , Aged , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Female , Humans , Levodopa/administration & dosage , Levodopa/adverse effects , Levodopa/therapeutic use , Male , Middle Aged , Parkinson Disease/drug therapy , Subthalamic Nucleus/drug effects , SyndromeABSTRACT
AIM: To analyze pharmacotherapy accompanied by deep brain stimulation of the subthalamic nucleus. MATERIAL AND METHODS: The study included 54 patients, who underwent bilateral STN DBS from 2003 to 2012. The severity of motor disturbances, activities of daily living and complications of dopaminergic therapy were estimated in accordance with II, III and IV parts of the Unified Parkinson's Disease Rating Scale (UPDRS) before operation and one, three and four years after it. L-dopa equivalent daily dose (LEDD) was assessed along with an analysis of the pharmacotherapy in whole. RESULTS AND CONCLUSION: By the end of the 1st year, the severity of motor disturbances in OFF-period decreased by 52.3% and remained stable for 3 years (51.8%), a slight increase of severity of motor disturbances was observed later, however it didn't reach the pre-operative level. The severity of motor fluctuations and drug-induced dyskinesia fell by 64.9%, 70.7% and 42.7% by the end of the first, third and fourth year of observation. The maximal decrease in LEDD was reached by the end of the 1st year and accounted for 57.7%; by the end of the third and fourth years it was 52.4% and 38.2%, respectively. During the 1st year, 16.7% of patients didn't take levodopa. The dose of pure levodopa decreased by the end of the 1st year by 64.6%, and by 56.7% and 43.7% by the end of the 3rd and 4th years, respectively. Monotherapy by an agonist of dopamine receptors (ADR) was received by 12.9% of patients, thus the share of ADR as part of the combined therapy increased in the postoperative period from 24.1% to 35.2%.
ABSTRACT
Objective. To assess the clinical efficacy of deep brain stimulation (DBS STN) of the subthalamic nucleus in patients with Parkinson´s disease (PD) compared to pharmacological treatment. Material and methods. DBS STN was applied to 22 patients (mean age 53.2 years, mean disease duration 9,6 years). The control group included 28 patients (mean age 54.2 years, mean disease duration 9,6 years) with PD who received pharmacological treatment. Patients were examined in OFF-medication and ON-medication conditions at 3, 6, 9, 12, 24, 36 months. The Unified Parkinson's Disease Rating Scale (UPDRS) part II, III, IV, the Hoehn and Yahr scale, the Schwab and England Scale, PDQ-39, the Hamilton Rating Scale for depression and the Spielberger Anxiety Scale were administered. All patients had motor fluctuations and dyskinesias. Results and conclusion. We demonstrated that DBS STN improved UPDRS II, III scores, reduced dyskinesias and motor fluctuations. After surgery, dopaminergic therapy was reduced by approximately 54.5%. In the control group, levodopa dose was increased by 20.5% to 36th month.
