Clinical Impact of Deep Brain Stimulation on the Autonomic System in Patients with Parkinson's Disease

Abstract

Background The role of deep brain stimulation (DBS) in the management of motor symptoms in patients with Parkinson's disease is well defined. However, it is becoming increasingly clear that DBS can either improve or worsen a number of non‐motor phenomena. Objectives We examined the published literature to better understand the effects on autonomic symptoms following DBS of the subthalamic nucleus and the globus pallidus interna. Methods We conducted a PubMed search of studies regarding the effects of DBS on the autonomic system published from January 2001. We searched for the following terms and their combinations: Parkinson's disease, deep brain stimulation, subthalamic nucleus, globus pallidus interna, autonomic dysfunction. Results Most studies reported in the literature focus on DBS targeting the subthalamic nucleus, with particular emphasis on favorable outcomes regarding gastrointestinal function and bladder control. However, the emergence or worsening of autonomic symptoms in subgroups of patients has also been documented. More controversial is the effect of stimulation on the cardiovascular, pulmonary, and thermo‐regulatory systems as well as sexual functioning. Data regarding the influence of DBS on the autonomic system when the target is the globus pallidus interna is less forthcoming, with target selection varying according to centre and clinical indication. Conclusions DBS appears to affect the autonomic nervous system, with varying degrees of influence, which may or may not be clinically beneficial for the patient. A better understanding of these effects could help personalize stimulation for individual patients with autonomic disorders and/or avoid autonomic symptoms in susceptible patients.

Impact of Subthalamic Nucleus Stimulation on Urinary Dysfunction and Constipation in Parkinson’s Disease

“…However, there are cases with significant worsening of symptoms following STN DBS surgery [20, 21]. The varied results suggest a complex interplay between DBS and non-surgical parameters, including disease duration, age, medication, and cerebral atrophy [1].…”

“…Urinary dysfunction and constipation are two common features of autonomic dysregulation in Parkinson’s disease, occurring in up to 71% and 80% of patients, respectively [1]. Detrusor overactivity is the hallmark of urinary dysfunction in PD [2].…”

“…Subthalamic nucleus deep brain stimulation (STN DBS), a well-established surgical procedure for PD, significantly improves motor symptoms, but the clinical impact of STN DBS on urinary dysfunction and constipation is variable and unpredictable [1]. Moreover, the neural mechanisms of STN DBS on urinary dysfunction and constipation is undetermined.…”

Personalised Advanced Therapies in Parkinson’s Disease: The Role of Non-Motor Symptoms Profile

“…Important conceptual advances may hold promise in relation to the delivery of personalised medicine and DAT in PD [ 2 ]. In addition to the abovementioned EuroInf studies, this is exemplified by several studies that have been conducted on the non-motor effects of DBS, showing improvements in several non-motor areas that have been reviewed elsewhere [ 39 , 40 , 41 , 42 , 43 , 44 ]. In brief, a recent meta-analysis, including 48 studies with mainly 12-month follow-up data, suggested post-STN-DBS improvements of depression and anxiety-related symptoms but increased apathy [ 41 ].…”

“…Another meta-analysis of seven studies with follow-up data ranging from three to 24 months showed post-STN-DBS improvements in sleep quality and restless leg syndrome; however, a high degree of heterogeneity among studies was reported [ 39 , 44 , 45 ], and few studies have investigated the effect of STN-DBS on REM sleep behaviour disorder [ 42 , 46 ]. Another recently published review summarised post-DBS positive outcomes related to urinary dysfunction (mean bladder volumes at desire and urge point to void), while controversial and limited data are available in relation to sexual, cardiovascular, thermoregulatory and gastrointestinal dysfunction [ 40 ]. Finally, even though presence of dementia is a contraindication for DBS, a systematic review of 13 studies showed that although there was a decline in verbal fluency and attention domains of cognition, other cognitive functions remained unchanged over a follow-up period ranging from six months to eight years [ 43 ].…”