Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspective
Abstract Subthalamic nucleus deep brain stimulation (STN DBS) is an established treatment that improves motor fluctuations, dyskinesia, and tremor in Parkinson’s disease (PD). After the surgery, a careful electrode programming strategy and medical management are crucial, because an imbalance between...
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| Format: | Article |
| Language: | English |
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Thieme Revinter Publicações
2020-04-01
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| Series: | Arquivos de Neuro-Psiquiatria |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020000400230&tlng=en |
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| author | Ana Paula BERTHOLO Carina FRANÇA Wilma Silva FIORINI Egberto Reis Barbosa Rubens Gisbert CURY |
| author_facet | Ana Paula BERTHOLO Carina FRANÇA Wilma Silva FIORINI Egberto Reis Barbosa Rubens Gisbert CURY |
| author_sort | Ana Paula BERTHOLO |
| collection | DOAJ |
| description | Abstract Subthalamic nucleus deep brain stimulation (STN DBS) is an established treatment that improves motor fluctuations, dyskinesia, and tremor in Parkinson’s disease (PD). After the surgery, a careful electrode programming strategy and medical management are crucial, because an imbalance between them can compromise the quality of life over time. Clinical management is not straightforward and depends on several perioperative motor and non-motor symptoms. In this study, we review the literature data on acute medical management after STN DBS in PD and propose a clinical algorithm on medical management focused on the patient’s phenotypic profile at the perioperative period. Overall, across the trials, the levodopa equivalent daily dose is reduced by 30 to 50% one year after surgery. In patients taking high doses of dopaminergic drugs or with high risk of impulse control disorders, an initial reduction in dopamine agonists after STN DBS is recommended to avoid the hyperdopaminergic syndrome, particularly hypomania. On the other hand, a rapid reduction of dopaminergic agonists of more than 70% during the first months can lead to dopaminergic agonist withdrawal syndrome, characterized by apathy, pain, and autonomic features. In a subset of patients with severe dyskinesia before surgery, an initial reduction in levodopa seems to be a more reasonable approach. Finally, when the patient’s phenotype before the surgery is the severe parkinsonism (wearing-off) with or without tremor, reduction of the medication after surgery can be more conservative. Individualized medical management following DBS contributes to the ultimate therapy success. |
| format | Article |
| id | doaj-art-bf4d71fdd7bc4ee5a68fc00fe66917c0 |
| institution | Kabale University |
| issn | 1678-4227 |
| language | English |
| publishDate | 2020-04-01 |
| publisher | Thieme Revinter Publicações |
| record_format | Article |
| series | Arquivos de Neuro-Psiquiatria |
| spelling | doaj-art-bf4d71fdd7bc4ee5a68fc00fe66917c02025-08-20T03:24:45ZengThieme Revinter PublicaçõesArquivos de Neuro-Psiquiatria1678-42272020-04-0178423023710.1590/0004-282x20190188Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspectiveAna Paula BERTHOLOhttps://orcid.org/0000-0003-2150-9300Carina FRANÇAhttps://orcid.org/0000-0001-8036-2439Wilma Silva FIORINIhttps://orcid.org/0000-0003-1214-9526Egberto Reis BarbosaRubens Gisbert CURYhttps://orcid.org/0000-0001-6305-3327Abstract Subthalamic nucleus deep brain stimulation (STN DBS) is an established treatment that improves motor fluctuations, dyskinesia, and tremor in Parkinson’s disease (PD). After the surgery, a careful electrode programming strategy and medical management are crucial, because an imbalance between them can compromise the quality of life over time. Clinical management is not straightforward and depends on several perioperative motor and non-motor symptoms. In this study, we review the literature data on acute medical management after STN DBS in PD and propose a clinical algorithm on medical management focused on the patient’s phenotypic profile at the perioperative period. Overall, across the trials, the levodopa equivalent daily dose is reduced by 30 to 50% one year after surgery. In patients taking high doses of dopaminergic drugs or with high risk of impulse control disorders, an initial reduction in dopamine agonists after STN DBS is recommended to avoid the hyperdopaminergic syndrome, particularly hypomania. On the other hand, a rapid reduction of dopaminergic agonists of more than 70% during the first months can lead to dopaminergic agonist withdrawal syndrome, characterized by apathy, pain, and autonomic features. In a subset of patients with severe dyskinesia before surgery, an initial reduction in levodopa seems to be a more reasonable approach. Finally, when the patient’s phenotype before the surgery is the severe parkinsonism (wearing-off) with or without tremor, reduction of the medication after surgery can be more conservative. Individualized medical management following DBS contributes to the ultimate therapy success.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020000400230&tlng=endeep brain stimulationmedical managementParkinson’s diseasephenotypesubthalamic nucleus |
| spellingShingle | Ana Paula BERTHOLO Carina FRANÇA Wilma Silva FIORINI Egberto Reis Barbosa Rubens Gisbert CURY Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspective Arquivos de Neuro-Psiquiatria deep brain stimulation medical management Parkinson’s disease phenotype subthalamic nucleus |
| title | Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspective |
| title_full | Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspective |
| title_fullStr | Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspective |
| title_full_unstemmed | Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspective |
| title_short | Medical management after subthalamic stimulation in Parkinson’s disease: a phenotype perspective |
| title_sort | medical management after subthalamic stimulation in parkinson s disease a phenotype perspective |
| topic | deep brain stimulation medical management Parkinson’s disease phenotype subthalamic nucleus |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020000400230&tlng=en |
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