Dyskinesias and grip control in Parkinson's disease are normalized by chronic stimulation of the subthalamic nucleus.

Abstract	Deep-brain stimulation of the subthalamic nucleus appears to reduce levodopa-induced dyskinesias, but whether this effect is caused by the reduction of the total levodopa ingestion or represents a direct effect on the motor system is unknown. Precision grip force of grasping movements and levodopa-induced dyskinesias was analyzed in 10 parkinsonian patients before and after 3 months of deep-brain stimulation of the subthalamic nucleus. Peak grip force was abnormally increased before surgery in the off-drug state and, particularly, in the on-drug state (sensitization). This grip force upregulation normalized with chronic deep-brain stimulation in both conditions (desensitization). Peak-dose dyskinesias also improved, and off-dystonia was completely abolished. Mean dosage of dopaminergic drugs was reduced, but force overflow and dyskinesias were equally improved in 2 patients without a reduction. Despite the same single levodopa test dose, force excess and levodopa-induced dyskinesias were drastically reduced after 3 months of deep-brain stimulation of the subthalamic nucleus. This indicates that direct effects of deep-brain stimulation of the subthalamic nucleus on levodopa-induced dyskinesias are likely to occur. Grip force overflow is a promising parameter to study the desensitizing effect of chronic deep-brain stimulation on levodopa-induced dyskinesias.
Authors	Roland Wenzelburger, Bao-Rong Zhang, Meike Poepping, Bettina Schrader, Dieter Müller, Florian Kopper, Urban Fietzek, Hubertus M Mehdorn, Günther Deuschl, Paul Krack
Journal	Annals of neurology (Ann Neurol) Vol. 52 Issue 2 Pg. 240-3 (Aug 2002) ISSN: 0364-5134 [Print] United States
PMID	12210799 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References	Levodopa
Topics	Dose-Response Relationship, Drug Dyskinesias (etiology, physiopathology, therapy) Electric Stimulation Therapy Hand Strength Humans Levodopa (administration & dosage, therapeutic use) Parkinson Disease (complications) Reference Values Severity of Illness Index Subthalamic Nucleus (physiopathology) Time Factors

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