Anti-cholinergics for axial symptoms in Parkinson's disease after subthalamic stimulation

• Published in: Clinical neurology and neurosurgery 2012-12, Vol.114 (10), p.1308-1311
• Main Authors: Baba, Yasuhiko, Higuchi, Masa-aki, Abe, Hiroshi, Fukuyama, Kouzou, Onozawa, Rieko, Uehara, Yoshinari, Inoue, Tooru, Yamada, Tatsuo
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Axial symptoms; Basal ganglia; Biological and medical sciences; Central nervous system diseases; Cholinergic Antagonists - therapeutic use; Deep brain stimulation; Deep Brain Stimulation - methods; Dopamine; Electrical stimuli; Female; Hospitals; Humans; Hypotheses; Male; Medical sciences; Middle Aged; Movement disorders; Neurodegenerative diseases; Neurology; Neurosurgery; Parkinson Disease - drug therapy; Parkinson Disease - therapy; Parkinson's disease; Posture; Prospective Studies; Subthalamic Nucleus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Trihexyphenidyl; Trihexyphenidyl - therapeutic use
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2012.03.046

Abstract Objective We studied the effect of anti-cholinergic therapy on axial symptoms that show a tendency to worsen over time after deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). Patients and methods We conducted a prospective study of 20 consecutive patients treated with the anti-cholinergic agent trihexyphenidyl after bilateral STN-DBS and assessed the effect of anti-cholinergic therapy on parkinsonism 1 month after its initiation using the Unified Parkinson's Disease Rating Scale (UPDRS). Results After a mean post-operative follow-up period of 22.3 months, the scores of axial symptoms on UPDRS part II (ADL score) and part III (motor score) deteriorated by 87% and 54% (baseline), respectively, compared with the pre-operative scores ( P < 0.001 for both comparisons). After adding trihexyphenidyl to dopaminergic medication with stimulation, the scores of axial symptoms on UPDRS part II and part III improved from baseline by 33% and 39%, respectively ( P < 0.001 for both comparisons). Conclusions Our findings demonstrated that the anti-cholinergic agent trihexyphenidyl shows positive effect for a patient population developing deterioration of axial symptoms after STN-DBS. The results in the present study may provide insights into the mechanism of emergence or progression of axial symptoms in patients with PD after STN-DBS.