Objective: To evaluate orthostatic blood pressure changes before and after subthalamic deep brain stimulation (STN-DBS) and to determine whether outcomes were related to DBS therapy or other factors such as postoperative drug adjustment.

Background: Orthostatic hypotension (OH) is common in Parkinson’s Disease (PD). Research shows a short-term improvement in symptom severity in the first year after DBS, but the extent is small and the clinical relevance remains unclear. It has been suggested that LEDD reduction secondary to STN-DBS may explain the OH changes.

Method: Blood pressure in the supine position and at 1 and 2 minutes after standing was measured at baseline and 1 year (± 4 months) after starting STN-DBS in PD patients. A total of 39 patients who presented with OH before or after DBS were included. OH was defined as a decrease in systolic blood pressure (ΔSBP) ≥ 20mmHg or diastolic blood pressure (ΔDBP) ≥ 10mmHg within 2 minutes of standing from the supine position. Pre- and postoperative blood pressure values were compared using paired t-tests. Patients were classified into improvement (from OH to normal), no improvement (OH to OH) and de novo (normal to OH) groups. Blood pressure changes were analyzed with ANOVA/Kruskal-Wallis and Fisher’s exact test. Correlations between LEDD reduction and hemodynamic changes were examined with Spearman’s rank correlation coefficient.

Results: The mean age at surgery was 66.2 ± 7[hi1] .1 years and the mean disease duration was 12.2 ± 5.8[hi2] years. STN-DBS did not produce any significant changes in ΔSBP (p=0.967) or ΔDBP (p=0.503). It was found that 33.33% (13 patients) showed OH improvement after 1 year of STN-DBS, 35.9% (14 patients) had no OH improvement, and 30.77% (12 patients) developed de novo OH. The patients with improvement had a significantly worse basal OH (SBP p=0.0097, DBP p<0.0001) compared to the other groups. LEDD reduction was not different between groups (p=0.2889) and was not correlated to changes in SBP (r=0.068, p=0.679) or DBP (r=-0.05, p=0.764). Starting postoperative MAO-B inhibitors was significantly associated with de novo OH (p=0.0015).

Conclusion: OH outcomes after STN-DBS differ among clinical subgroups and are not explained by LEDD reduction, suggesting that additional patient-specific factors like basal autonomic state or drug adjustment may have more influence in postoperative autonomic responses.

« Back to 2026 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-effects-on-parkinsons-disease-patients-with-orthostatic-hypotension/