Levodopa / opicapone as a complement to STN-DBS in clinical practice. A retrospective single-centre analysis

Area of Science:

• Neurology
• Neurosurgery
• Pharmacology

Background:

• Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a key treatment for Parkinson's disease, enabling medication reduction.
• Optimal medication strategies post-STN-DBS, particularly involving catechol-O-methyltransferase (COMT) inhibitors like opicapone, are not well-defined.
• COMT inhibitors are often discontinued after STN-DBS, despite their potential for sustained dopaminergic stimulation.

Purpose of the Study:

• To identify the clinical characteristics of patients receiving opicapone after STN-DBS.
• To determine factors associated with the need for enhanced dopamine-stabilizing therapies post-STN-DBS.
• To evaluate the efficacy of opicapone in managing motor fluctuations in Parkinson's disease patients post-STN-DBS.

Main Methods:

• Retrospective analysis of a single-center cohort.
• Comparison of patients treated with STN-DBS + levodopa + opicapone (n=16) against an age-matched control group without opicapone.
• Assessment of MDS-UPDRS III and IV scores and levodopa equivalent dosages (LED) pre- and post-surgery (≥5 months).

Main Results:

• The opicapone group had higher preoperative UPDRS-IV A scores, indicating more dyskinesias.
• Postoperatively, the opicapone cohort exhibited more pronounced motor fluctuations (MDS-UPDRS IV) but not significantly different from controls.
• The opicapone group showed a smaller reduction in dopaminergic medication post-STN-DBS compared to the control group.

Conclusions:

• Patients selected for opicapone post-STN-DBS present a phenotype with significant motor fluctuations, suggesting a need for more stable dopamine replacement.
• Levodopa combined with opicapone (COMT inhibition) may be a viable strategy for these patients.
• Further prospective studies are required to fully determine the clinical benefits of opicapone in this population.