The impact of bilateral subthalamic nucleus deep brain stimulation on dyskinesia and levodopa equivalent daily dose in advanced Parkinson’s disease

Abstract

Abstract OBJECTIVE: To assess the effect of bilateral subthalamic nucleus deep brain stimulation (B/L STN DBS) on the progression of dyskinesia and the levodopa equivalent daily dose (LEDD) in advanced Parkinson’s disease (APD) patients 6 months postoperatively. METHODS: Seventeen APD patients aged 21–80 years with the minimum modified Hoen & Yahr score of 2 while off medication and poor motor function underwent B/L STN DBS from January 2021 to December 2021. They were assessed preoperatively and 6 months postoperatively using the Unified dyskinesia rating scale (UDysRS) and Unified Parkinson’s Disease Rating Scale Part IV (UPDRS IV) for dyskinesia and LEDD dosage. RESULTS: Significant improvement was observed postoperatively in both UDysRS (pre-op 66.53±24.59, post-op 30.88±12.01; P = 0.000) and UPDRS IV (pre-op 9.24±1.75, post-op 5.76±1.39; P = 0.000) scores. The overall clinical improvement using UDysRS was 52.23±16.23%. Each subscale of UDysRS showed significant improvement postoperatively: ON dyskinesia (pre-op 21±7.7, post-op 13.76±5.79; P < 0.05); OFF dystonia (pre-op 8.53±3.26, post-op 4.94±2.70; P < 0.05); impairment (face, pre-op 2.47±2.52, post-op 0.29±0.98, P < 0.05; neck and trunk, pre-op 6.29±4.55, post-op 0.59±0.87, P < 0.05; arms, pre-op 13.06±5.86, post-op 5.76±3.7, P < 0.05; and legs, pre-op 7.18±5.12, post-op 1.29±1.57, P < 0.05); and disability (pre-op 8±3.46, post-op 4.24±2.25; P < 0.05), suggesting high clinical significance. LEDD (pre-op 673.41±212.69mg, post-op 386.82±133.01mg; P = 0.000) showed significant reduction in dosage 6 months postoperatively. LEDD reduction and dyskinesia improvement showed mild-to-moderate positive correlation (r = 0.404). CONCLUSION: B/L STN DBS helps in improving dyskinesia by reducing LEDD in APD patients.