Document Type : Special Articles

Authors

• Kandadai Rukmini Mridula ¹
• Rupam Borgohain ¹
• Shaik Afshan Jabeen ¹
• Gaddamanugu Padmaja ¹
• Vcs Srinivasarao Bandaru ²
• Praveen Ankathi ³
• Meena A Kanikannan ¹
• Mohammed Shujath Ali Khan ¹

¹ Department of Neurology, Nizam's Institute of Medical Sciences, Autonomous University, Hyderabad, India.

² Department of Research, Yashoda Hospital Somajiguda Hyderabad, India.

³ Department of Neurosurgery, Nizam's Institute of Medical Sciences, Autonomous University, Hyderabad, India.

Abstract

Background: Non motor symptoms (NMS) of idiopathic Parkinson’s disease (PD) are a major cause of disability and recognition of these symptoms and treatment is important for comprehensive health care. Deep   brain   stimulation   of   bilateral   subthalamic nucleus deep brain stimulation (STN DBS) has been shown to improve motor symptoms in PD and effects on NMS are unknown. To investigate the NMS among PD patients who underwent STN DBS.Methods: We recruited prospectively 56 patients with PD, who had undergone bilateral STN DBS and 53 age and duration of illness  matched PD patients on dopaminergic therapy (controls). NMS were assessed using 30 item questionnaire NMS Quest. These questions  evaluated  9 domains, gastrointestinal, urinary,  cardiovascular, sexual, cognition (apathy/attention/memory), anxiety/depression, hallucinations/delusions, sleep an dmiscellaneous. Comparison was done on individual symptoms as well as  in  various  domains.  This  study  was  carried  at Nizam’s  Institution  of  Medical  Sciences  and  study period was from January 2011 to December 2012. Results:  Patients  who underwent STN  DBS  had  a significantly lower  mean  total  score  on  NMS  quest (6.7   ±   3.8)   compared   to   controls   (8.4   ±   3.7) (P   <   0.00100).  Symptoms   in   the   domains   of cardiovascular, gastrointestinal, sleep were significantly less    frequent  while  sexual  disturbances  were significantly more frequent among patients compared to controls.  On  individual  symptom  analysis,  nocturia (P  <  0.00010),  unexplained  pains  (P  <  0.00010), nausea  and  vomiting,  constipation,  lightheadedness, depression, and insomnia were less prevalent, while sexual disturbances were significantly more common in STN DBS group compared to controls.Conclusion: Bilateral STN DBS not only improves the motor symptoms but also improves many NMS in PD patients.