Direct inhibition of levodopa-induced beginning-of-dose motor deterioration by subthalamic nucleus stimulation in a patient with Parkinson disease

Case report

Hideki Oshima M.D., Ph.D. 1 , 2 , Yoichi Katayama M.D., Ph.D. 1 , 2 , Chikashi Fukaya M.D., Ph.D. 1 , 2 , Toshikazu Kano M.D. 2 , Kazutaka Kobayashi M.D., Ph.D. 2 , Takamitsu Yamamoto M.D., Ph.D. 1 , 2 , and Yutaka Suzuki M.D., Ph.D. 1 , 3
View More View Less
  • 1 Division of Applied System Neuroscience, and
  • 2 Departments of Neurological Surgery and
  • 3 Neurology, Nihon University School of Medicine, Tokyo, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓Beginning-of-dose motor deterioration (BDMD) is a complication of levodopa medications in Parkinson disease (PD) that is presumably caused by inhibitory effects of levodopa. Only limited experience of BDMD has been described in the literature. The authors report the case of a patient with PD who demonstrated a marked BDMD while being treated with standard levodopa medications. This 55-year-old woman had a 12-year history of PD and a 10-year history of levodopa treatment. Marked exacerbation of symptoms occurred 15 to 20 minutes after every dose of levodopa at 100 mg and lasted approximately 15 minutes. The PD symptoms, particularly tremor and rigidity, were exacerbated more markedly during this period than during the wearing-off deterioration. The BDMD could be controlled very well by subthalamic nucleus (STN) stimulation without any change in the regimen of levodopa medications. These observations suggest that the BDMD was inhibited by STN stimulation through a direct effect.

Abbreviations used in this paper:BDMD = beginning-of-dose motor deterioration; PD = Parkinson disease; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Hideki Oshima, M.D., Ph.D., Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan. email: hoshima@med.nihon-u.ac.jp.
  • 1

    Burchiel KJ, , Anderson VC, , Favre J, & Hammerstad JP: Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: results of a randomized, blinded pilot study. Neurosurgery 45:13751382, 1999

    • Search Google Scholar
    • Export Citation
  • 2

    Contin M, , Riva R, , Martinelli P, , Procaccianti G, , Cortelli P, & Avoni P, : Response to a standard oral levodopa test in Parkinsonian patients with and without motor fluctuations. Clin Neuropharmacol 13:1928, 1990

    • Search Google Scholar
    • Export Citation
  • 3

    Davis TL, , Brughitta G, , Baronti F, & Mouradian MM: Acute effects of pulsatile levodopa administration on central dopamine pharmacodynamics. Neurology 41:630633, 1991

    • Search Google Scholar
    • Export Citation
  • 4

    Deep-Brain Stimulation for Parkinson's Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:956963, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Hashimoto T, , Elder CM, , Okun MS, , Patrick SK, & Vitek JL: Stimulation of the subthalamic nucleus changes the firing pattern of pallidal neuron. J Neurosci 23:19161923, 2003

    • Search Google Scholar
    • Export Citation
  • 6

    Hughes AJ, , Lees AJ, & Stern GM: Apomorphine test to predict dopaminergic responsiveness in parkinsonian syndromes. Lancet 336:3234, 1990

    • Search Google Scholar
    • Export Citation
  • 7

    Hutchinson WD, , Levy R, , Dostrovsky JO, , Lozano AM, & Lang AE: Effects of apomorphine on globus pallidus neurons in parkinsonian patients. Ann Neurol 42:767775, 1997

    • Search Google Scholar
    • Export Citation
  • 8

    Katayama Y, , Kasai M, , Oshima H, , Fukaya C, , Yamamoto T, & Ogawa K, : Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients. J Neurosurg 95:213221, 2001

    • Search Google Scholar
    • Export Citation
  • 9

    Krack P, , Batir A, , Van Blercom N, , Chabardes S, , Fraix V, & Ardouin C, : Five-year follow-up of bilateral stimulation of the sub-thalamic nucleus in advanced Parkinson's disease. N Engl J Med 349:19251934, 2003

    • Search Google Scholar
    • Export Citation
  • 10

    Kumar R, , Lozano AM, , Kim YJ, , Hutchison WD, , Sime E, & Halket E, : Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 51:850855, 1998

    • Search Google Scholar
    • Export Citation
  • 11

    Levy R, , Dostrovsky JO, , Lang AE, , Sime E, , Hutchison WD, & Lozano AM: Effects of apomorphine on subthalamic nucleus and globus pallidus internus neurons in patients with Parkinson's disease. J Neurophysiol 86:249260, 2001

    • Search Google Scholar
    • Export Citation
  • 12

    Merello M, & Lees AJ: Beginning-of-dose motor deterioration following the acute administration of levodopa and apomorphine in Parkinson's disease. J Neurol Neurosurg Psychiatry 55:10241026, 1992

    • Search Google Scholar
    • Export Citation
  • 13

    Merello M, , Lees AJ, , Balej J, , Cammarota A, & Leiguarda R: GPi firing rate modification during beginning-of-dose motor deterioration following acute administration of apomorphine. Mov Disord 14:481483, 1999

    • Search Google Scholar
    • Export Citation
  • 14

    Moro E, , Scerrati M, , Romito LM, , Roselli R, , Tonali P, & Albanese A: Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson's disease. Neurology 53:8590, 1999

    • Search Google Scholar
    • Export Citation
  • 15

    Nimura T, , Yamaguchi K, , Ando T, , Shibuya S, , Oikawa T, & Nakagawa A, : Attenuation of fluctuating striatal synaptic dopamine levels in patients with Parkinson disease in response to subthalamic nucleus stimulation: a positron emission tomography study. J Neurosurg 103:968973, 2005

    • Search Google Scholar
    • Export Citation
  • 16

    Nutt JG, , Gancher ST, & Woodward WR: Does an inhibitory action of levodopa contribute to motor fluctuations?. Neurology 38:15531557, 1988

    • Search Google Scholar
    • Export Citation
  • 17

    Nutt JG, & Holford NHG: The response to levodopa in Parkinson's disease: imposing pharmacological law and order. Ann Neurol 39:561573, 1996

    • Search Google Scholar
    • Export Citation
  • 18

    Nutt JG, , Rufener SL, , Carter JH, , Anderson VC, , Phawa R, & Hammerstad JP, : Interactions between deep brain stimulation and levodopa in Parkinson's disease. Neurology 57:18351842, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Paalzow GH, & Paalzow LK: L-DOPA: how it may exacerbate parkinsonian symptoms. Trends Pharmacol Sci 9:1519, 1986

  • 20

    Skirboll LR, , Grace AA, & Bunney BS: Dopamine auto- and post-synaptic receptors: electrophysiological evidence for differential sensitivity to dopamine agonists. Science 206:8082, 1979

    • Search Google Scholar
    • Export Citation
  • 21

    Welter ML, , Houeto JL, , Bonnet AM, , Bejjani PB, , Mesnage V, & Dormont D, : Effects of high-frequency stimulation on subthalamic neuronal activity in parkinsonian patients. Arch Neurol 61:8996, 2004

    • Search Google Scholar
    • Export Citation
  • 22

    Westfall TC, , Besson MJ, , Giorguieff MF, & Glowinski J: The role of presynaptic receptors in the release and synthesis of 3H-dopamine by slices of rat striatum. Naunyn Schmiedebergs Arch Pharmacol 292:279289, 1976

    • Search Google Scholar
    • Export Citation
  • 23

    Wichmann T, & DeLong MR: Functional and pathophysiological models of the basal ganglia. Curr Opin Neurobiol 6:751758, 1996

Metrics

All Time Past Year Past 30 Days
Abstract Views 298 136 14
Full Text Views 65 2 0
PDF Downloads 27 2 0
EPUB Downloads 0 0 0