Affiliation:
1. Department of Biomedical and NeuroMotor Sciences (DIBINEM) Alma Mater Studiorum—University of Bologna Bologna Italy
2. IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
Abstract
AbstractBackgroundBlood pressure control in Parkinson's disease (PD) under subthalamic deep brain stimulation (STN‐DBS) is influenced by several intertwined aspects, including autonomic failure and levodopa treatment.ObjectiveTo evaluate the effect of chronic STN‐DBS, levodopa, and their combination on cardiovascular autonomic functions in PD.MethodsWe performed cardiovascular reflex tests (CRTs) before and 6‐months after STN‐DBS surgery in 20 PD patients (pre‐DBS vs. post‐DBS). CRTs were executed without and with medication (med‐OFF vs. med‐ON).ResultsCRT results and occurrence of neurogenic orthostatic hypotension (OH) did not differ between pre‐ and post‐DBS studies in med‐OFF condition. After levodopa intake, the BP decrease during HUTT was significantly greater compared to med‐OFF, both at pre‐DBS and post‐DBS evaluation. Levodopa‐induced OH was documented in 25% and 5% of patients in pre‐DBS/med‐ON and post‐DBS/med‐ON study.ConclusionChronic stimulation did not influence cardiovascular responses, while levodopa exerts a relevant hypotensive effect. The proportion of patients presenting levodopa‐induced OH decreases after STN‐DBS surgery.