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NEUROLOGY 2006;67:1781-1785
© 2006 American Academy of Neurology

Deep brain stimulation improves orthostatic regulation of patients with Parkinson disease

B. Stemper, MD, A. Beric, MD, G. Welsch, MD, T. Haendl, MD, D. Sterio, MD and M. J. Hilz, MD

From the Department of Neurology, University of Erlangen-Nuernberg (B.S., G.W., T.H., M.J.H.), Germany; and the Department of Neurology, New York University (A.B., D.S., M.J.H.).

Address correspondence and reprint requests to Max J. Hilz, MD, Professor of Neurology, Department of Neurology, New York University School of Medicine, 550 First Avenue, Suite NB 7W11, New York, NY 10016; e-mail: max.hilz{at}neuro.med.uni-erlangen.de

Objective: To evaluate whether subthalamic nucleus (STN) stimulation has an effect on the orthostatic regulation of patients with Parkinson disease (PD), we studied cardiovascular regulation during on and off phases of STN stimulation.

Methods: We examined 14 patients with PD (mean age 58.1 ± 5.8 years, 4 women, 10 men) with bilateral STN stimulators. Patients underwent 3 minutes of head-up tilt (HUT) testing during STN stimulation and after 90 minutes interruption of stimulation. We monitored arterial blood pressure (BP), RR intervals (RRI), respiration, and skin blood flow (SBF). Baroreflex sensitivity (BRS) was assessed as the square root of the ratio of low-frequency power of RRI to the low-frequency power of systolic BP for coherences above 0.5.

Results: During the on phase of the STN stimulation, HUT induced no BP decrease, a significant tachycardia, and a significant decrease of SBF. During the off phase of stimulation, HUT resulted in significant decreases in BPsys and RRI and only a slight SBF decrease. HUT induced no change of BRS during stimulation, but lowered BRS when the stimulator was off (p < 0.05).

Conclusions: STN stimulation of patients with PD increases peripheral vasoconstriction and BRS and stabilizes BP, thereby improving postural hypotension in patients with PD. The results indicate that STN stimulation not only alleviates motor deficits but also influences autonomic regulation in patients with PD.

Received December 13, 2005. Accepted in final form August 3, 2006.

Disclosure: The authors report no conflicts of interest.


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