Abstract 11416: The Effect of Deep Brain Stimulation on Autonomic Dysfunction in Parkinson Disease
Background. Standing from supine position rapidly increases sympathetic tone to adapt the circulation to the upright position. Due to the increased sympathetic tone, the heart rate (HR) and blood pressure (BP) increases to prevent orthostatic hypotension. In patients with Parkinson disease (PD), the autonomic nervous system can be effected resulting in inadequate adaptation to standing. Deep brain stimulation (DBS) is a treatment option for medically intractable tremor in PD. Based on recent studies, DBS seems to modulate the neuronal network rather than merely exciting or inhibiting basal ganglia nuclei. The functional modulation also effects the surrounding and remote connecting areas. This study tested the hypothesis that DBS may normalize the autonomic dysfunction in PD.
Methods. 9 Subjects with PD and DBS (DBS Group), 8 patients with PD without DBS (PD group) and 46 healthy subjects (HS group) underwent BP and HR measurement after 5 min resting (supine) and within 1 min after standing. Changes in HR, BP and MAP from supine to upright position were analyzed.
Results: Upon standing, HR increased (76±10 to 91±12 bpm, p<0.001) in HS. The HR also increased in DBS (75±11 to 83±12 bpm, p<0.01), while it did not change in PD (75±18 vs. 75±12 bpm). The systolic BP increased in HS (115±9 to 125±10 mmHg ,9%, p<0.001). In both PD and DBS, the systolic BP decreased but to a lesser extent in DBS (134±24 to 124±25 mmHg, 7%) versus PD (143±20 to 127±28 mmHg, 16%). The diastolic BP increased in HS (75±7 to 85±9 mmHg, 13%, p<0.001) and in DBS (80±10 to 84±11 mmHg, 6% p<0.05), while it did not change in PD (82±14 vs. 82±12 mmHg). The MAP increased in HS by 11% (88±6 to 98±8, p<0.001) did not change in DBS (98±14 vs. 98±15 mmHg), and decreased in PD by 5% (103±16 vs. 97±17 mmHg). The percentage of subjects that had at least 10 mmHg drop in systolic BP was 2% in HS, 22% in DBS and 63% in PD, p<0.001. Upon standing, decrease in HR was not seen in HS, while 11% in DBS and 50% in PD (p<0.001).
Conclusion. PD patient showed a lack of circulatory adaptation to standing. DBS patients showed a better adaptation than PD patients, which was similar to the adaptation seen in HS. DBS may effect the autonomic nervous system in PD, normalizing autonomic dysfunction
- © 2012 by American Heart Association, Inc.