Pharmacotherapy accompanied by deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease

Abstract

To analyze pharmacotherapy accompanied by deep brain stimulation of the subthalamic nucleus. The study included 54 patients, who underwent bilateral STN DBS from 2003 to 2012. The severity of motor disturbances, activities of daily living and complications of dopaminergic therapy were estimated in accordance with II, III and IV parts of the Unified Parkinson's Disease Rating Scale (UPDRS) before operation and one, three and four years after it. L-dopa equivalent daily dose (LEDD) was assessed along with an analysis of the pharmacotherapy in whole. By the end of the 1st year, the severity of motor disturbances in OFF-period decreased by 52.3% and remained stable for 3 years (51.8%), a slight increase of severity of motor disturbances was observed later, however it didn't reach the pre-operative level. The severity of motor fluctuations and drug-induced dyskinesia fell by 64.9%, 70.7% and 42.7% by the end of the first, third and fourth year of observation. The maximal decrease in LEDD was reached by the end of the 1st year and accounted for 57.7%; by the end of the third and fourth years it was 52.4% and 38.2%, respectively. During the 1st year, 16.7% of patients didn't take levodopa. The dose of pure levodopa decreased by the end of the 1st year by 64.6%, and by 56.7% and 43.7% by the end of the 3rd and 4th years, respectively. Monotherapy by an agonist of dopamine receptors (ADR) was received by 12.9% of patients, thus the share of ADR as part of the combined therapy increased in the postoperative period from 24.1% to 35.2%.