Objective: To analyse global pharmacological adjustment after Deep Brain Stimulation (DBS) in Parkinson’s Disease (PD) patients, and secondarily its relation with Non Motor Symptoms (NMS).

Background: Levodopa-equivalent daily dose (LEDD) reduction after DBS has been proved in many studies. However, management of non-levodopa drugs and non-dopaminergic treatment is not well established yet.

Method: Retrospective study in PD patients after DBS in clinical practice. Clinical scales were collected at baseline and after 1 year. A pharmacological analysis was performed including all Parkinson-related drugs.

Results: 40 patients were enrolled (34 STN-DBS, 6 GPI-DBS). The disease duration was 11.2 years (SD3.9), Off UPDRS-III mean punctuation was 41.03 (SD1.9).
All subjects had SNM at baseline (32.6% medium/severe) and 63.5% had Non-Motor-Fluctuations (NMF)
At 1 year of follow-up, DBS had allowed >74% Off-Time decrease and 35% LEDD reduction (525.12mg,SD 89,3). None ofthe patients had achieved monotherapy. 57.5% had decreased dopaminergic agonist (DA) more than 50%.
27% had needed to start or increase doses of antidepressant and/or benzodiazepines. 5% had started antichollinergics/alfablockers and 5% had required cholinesterase inhibitors.
Significant differences were not found in NMSQ comparing baseline and at the end of follow-up (7.5 after DBS, 2-14). Near 90% patients recognized no improvement/worsening of depression and/or anxiety. 85% continued with NMF, only 32% perceived global SNM improvement.

Conclusion: DBS is very effective for motor symptoms and to decrease motor fluctuations, which allows reducing dopaminergic drugdoses considerably.
However, efficacy in NMS, specially neuropsychiatric symptoms, does notseem to beso well demonstrated, DA withdrawal could be an hypothesis.
Polypharmacy in PD, targeting both dopaminergic and non-dopaminergic system, is a common clinical practise to control NMS 1 year after surgery.

References: 1. Dafsari HS, et al. EUROPAR and the IPMDS Non Motor PD Study Group. Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease. Brain Stimul. 2020 2. Kurtis MM, Rajah T, Delgado LF, Dafsari HS. The effect of deep brain stimulation on the non-motor symptoms of Parkinson’s disease: a critical review of the current evidence. NPJ Parkinsons Dis. 2017 3. Picilo M. et al. Levodopa Versus Dopamine Agonist After Subthalamic Stimulation in Parkinson’s Disease. Mov Dis.2020

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopaminergic-and-non-dopaminergic-treatment-after-deep-brain-stimulation-dbs-in-parkinson-disease-pd-importance-of-non-motor-symptoms-nms/