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Abstract Details

Unraveling the Intertwined Relationship of DBS, Parkinson's Disease Subtype and LEDD: A Retrospective Study
Movement Disorders
P9 - Poster Session 9 (11:45 AM-12:45 PM)
5-014

To assess the impact of deep brain stimulation (DBS) target and Parkinson’s disease (PD) motor subtype on the total levodopa equivalent daily dose (LEDD) following surgery.
DBS is an effective therapy for patients with PD and refractory motor complications. The globus pallidus interna (GPi) and the subthalamic nucleus (STN) are the most common targets for DBS implantation. Although early randomized studies found these targets to be equally efficacious, STN DBS is preferred given its association with a greater reduction in LEDD. The impact of DBS on LEDD long term and with relation to the PD phenotype remains incompletely investigated.

A retrospective study of PD patients who were implanted with bilateral GPi or STN DBS from 2003 to 2019 and satisfied our inclusion criteria was conducted. Data including demographics, DBS surgery data, LEDD and the Unified Parkinson’s Disease Rating Scale Part III (UPDRS) was recorded. The UPDRS was used to categorize subjects into two motor phenotypes - tremor dominant (TD) and non-TD PD. LEDD up to 5 years post-DBS implantation were collected. A general linear model with repeated measures to analyze the relation between LEDD, DBS target and motor phenotype was performed using SPSS v28.0.1.1(14).
Clinical data from 95 patients (21 TD and 74 non-TD) was analyzed. No significant impact of motor phenotype (p = 0.533) or time (p = 0.06) on LEDD changes after DBS up to 5 years of follow up was noted. However, patients with STN DBS implantation (n=45) showed greater reduction in LEDD (235+/- 11) compared to GPi DBS implantation (35+/-3) (p = 0.04). We found that LEDD decreases in a fashion that changes constantly rather than a linear trend after DBS (p = 0.01). 
Bilateral STN DBS is associated with a greater medication decrease and LEDD decreases in a nonlinear fashion after DBS.
Authors/Disclosures
Tejas R. Mehta, MD
PRESENTER 		Dr. Mehta has nothing to disclose.
Venkat S. Lavu, MBBS (University of Arkansas Medical Sciences) Dr. Lavu has nothing to disclose.
Christopher Hess, MD (University of Florida Fixel Institute for Neurological Diseases) The institution of Dr. Hess has received research support from Parkinson's Foundation.
Adolfo Ramirez Zamora, MD (University of Louisville) Dr. Ramirez Zamora has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel therapeutics. Dr. Ramirez Zamora has received personal compensation in the range of $0-$499 for serving as a Consultant for NeuroPacs. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Iota Inc. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Maplight. Dr. Ramirez Zamora has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of Dr. Ramirez Zamora has received research support from Parkinsons Foundation.
Michael S. Okun, MD, FAAN (University of Florida) Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.
Joshua Wong, MD (University of Florida College of Medicine - Neurology) The institution of Dr. Wong has received research support from NIH.