Objective: We aimed to evaluate the long-term changes in medication of patients with advanced Parkinson’s disease (PD) following STN-DBS in our center.

Background: Usually antiParkinsonian medication under STN-DBS can be noticeably optimized. Strategy of postoperative PD management differs between the movement disorder clinics.

Methods: We assessed 71 PD patients treated with STN-DBS. Minimal follow-up was two years. Mean age at surgery was 54.4±9.1 years; disease duration – 12.3±4.5 years; Hoehn&Yahr stage – 3.5±0.6. AntiParkinsonian medication regimens before STN-DBS and appropriate adjustments under continuous neurostimulation were analyzed yearly, maximum follow-up was 5 years.

Results: Before surgery, all patients received levodopa; 14 (20% of patients) – more than 2000 mg daily. 22 (31%) patients were on monotherapy with levodopa; 29 (41%) patients took three and more types of antiParkinsonian drugs. In the first year of STN-DBS, levodopa-dose was reduced by 65±25% and total levodopa equivalent daily dose (LEDD) was reduced by 51±26%; in the second year, by 64±26% and 52±25%; in the third year, by 62±26% and 49±24% (46 patients analyzed); in the fourth, by 60±26% and 47±27% (33 patients analyzed); in the fifth, by 57±26% and 43±30% (26 patients analyzed), respectively. Furthermore, to the 5th year of neurostimulation, the number of patients taking levodopa/COMT-inhibitor combinations and prolonged-release levodopa preparations significantly decreased. No patients discontinued medication completely. After the 2nd year of STN-DBS, 21 (30%) patients stayed on monotherapy (levodopa or dopamine agonist); in 12 (17%) patients levodopa could be withdrawn; proportion of patients receiving dopamine agonists increased from 59% before surgery to 77%. After the 5th year of STN-DBS, 5 (19%) patients were still on monotherapy, 2 (7.7%) patients did not receive levodopa, 24 (92%) patients had dopamine agonists in medication scheme. At the same time 10 (38%) patients still needed multi-drug treatment; in 19% of patients, antidepressants were required.

Conclusions: STN-DBS allowed a considerable stable reduction in dopaminergic medication (levodopa-dose and levodopa equivalent daily dose). Medication could be partially simplified. Therapeutic regimens based on predominant decrease in pure levodopa-dose with increasing role of dopamine agonists showed safety in long-term follow-up.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antiparkinsonian-medication-adjustments-following-deep-brain-stimulation-of-subthalamic-nucleus-in-patients-with-advanced-parkinsons-disease/