Troubleshooting in hospitalized Parkinson's disease patients with a history of deep brain stimulation of the subthalamic nucleus

Abstract

AbstractBackgroundDeep brain stimulation is a treatment option for patients with Parkinson's disease who have motor complications, such as wearing off and dyskinesia. However, in some cases, the benefits of deep brain stimulation seem to diminish over time.AimWe aimed to investigate the reasons for hospitalization of Parkinson's disease patients who were previously implanted with subthalamic nucleus deep brain stimulation devices. We also aimed to investigate the efficacy of our management of problems related to deep brain stimulation and/or Parkinson's disease‐related neurological symptoms.MethodsA retrospective chart review was carried out on all hospitalized cases of patients who were previously implanted subthalamic nucleus deep brain stimulation at our hospital or other institutions.ResultsA total of 78 hospitalizations (47 patients) were identified. Of these, 34 hospitalizations (24 patients) were as a result of worsening of Parkinson's disease‐related or stimulation‐related problems. The reasons for 34 hospitalizations included wearing‐off/on‐off (n = 17), dyskinesia (n = 12), gait disturbance (n = 5), dysarthria (n = 4), camptocormia (n = 5), hallucination (n = 6) and other psychiatric problems (n = 10). Most of these problems were successfully managed by adjusting both medications and stimulation parameters (31 cases, 91.2%). No case was improved by only adjusting stimulation. The Unified Parkinson's Disease Rating Scale part III score improved by 24.5% (P = 0.02) by hospitalized management.ConclusionAppropriate management of medications and stimulation are most important for patients who have already undergone deep brain stimulation in order to maximize the benefits.