Session Information
Date: Tuesday, September 24, 2019
Session Title: Parkinsonisms and Parkinson-Plus
Session Time: 1:45pm-3:15pm
Location: Agora 3 West, Level 3
Objective: The present study aims to: i) systematically evaluate literature data on acute medical management after subthalamic nucleus (STN) deep brain stimulation (DBS) and, ii) propose a clinical algorithm focused on the patient’s phenotypic profile.
Background: STN-DBS is an established and effective form of treatment that improves motor fluctuations, dyskinesia and quality of life in patients with Parkinson’s Disease (PD). The keys points for the success of the procedure are the medical management and the programming strategies following DBS, in both the early and the long-term follow-up. Overall, the levodopa equivalent daily dose (LEDD) is reduced by 30 to 50% one year after surgery among the trials, but it is not well established how this reduction should be performed, with little scientific evidence to aid the medical management of these patients.
Method: A systematic evaluation of literature data on acute medical management after STN DBS was performed.
Results: The major modifications in medication dosage occurred during the initial postoperative period. Initially, the aim is to withdraw sequentially anticholinergic medications, followed by COMT inhibitors, amantadine and MAO inhibitor. In patients taking high doses of dopaminergic agonists, its initial reduction is recommended in order to avoid the hyperdopaminergic syndrome, particularly hypomania. On the other hand, a rapid withdrawal of dopaminergic agonists can lead to dopaminergic agonist withdrawal syndrome, characterized by apathy, pain and autonomic features. Finally, in a subset of patients with severe dyskinesia before the surgery, an initial reduction in levodopa seems to be a more reasonable approach.
Conclusion: A slow, progressive increase of STN DBS allows a decrease in dopaminergic drug dose, resulting in improvement of dyskinesia and of impulse control disorders. Changes in dopaminergic drug treatment, whether increases or decreases, should always be made progressively to avoid overstimulation and withdrawal syndromes. Pharmacological management after DBS should be individualized according to the patients clinical characteristics and baseline medications. Hyperdopaminergic and hypodopaminergic syndromes together with severe dyskinesia are the most challenges issues, and further studies are needed to better customize the medical management following STN DBS.
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To cite this abstract in AMA style:
A. Bertholo, R. Cury. Medical management after subthalamic nucleus deep brain stimulation in patients with Parkinson’s Disease [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/medical-management-after-subthalamic-nucleus-deep-brain-stimulation-in-patients-with-parkinsons-disease/. Accessed December 11, 2024.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/medical-management-after-subthalamic-nucleus-deep-brain-stimulation-in-patients-with-parkinsons-disease/