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Understanding dopaminergic dose reduction following STN-DBS: mediation analysis.

Aymeric Lanore1, Marion Houot2, Aymeric Basset3

  • 1Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière University Hospital, Paris, France.

BMJ Neurology Open
|January 21, 2026
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Summary

Predictors of levodopa equivalent dopaminergic dose reduction after subthalamic nucleus deep brain stimulation in Parkinson's disease include baseline dose, axial impairment, and stimulation spread. These factors influence medication management post-surgery.

Keywords:
NEUROSURGERYPARKINSON'S DISEASEPHARMACOLOGY

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Area of Science:

  • Neurology
  • Neurosurgery
  • Pharmacology

Background:

  • Subthalamic nucleus deep brain stimulation (STN-DBS) is a treatment for Parkinson's disease (PD).
  • The reduction in levodopa equivalent dopaminergic dose (LEDD) after STN-DBS varies significantly among patients.
  • Identifying predictors of LEDD reduction is crucial for optimizing patient selection and programming of STN-DBS.

Purpose of the Study:

  • To identify predictors of LEDD reduction in Parkinson's disease patients undergoing STN-DBS.
  • To investigate whether motor improvement mediates the relationship between predictors and LEDD reduction.

Main Methods:

  • Analysis of data from 144 patients treated with STN-DBS.
  • Utilized the Boruta algorithm to identify predictors of LEDD reduction.
  • Employed a structural equation model to assess direct and motor-mediated effects.

Main Results:

  • Mean LEDD reduction was 41.7% and motor improvement was 48.6% at 1 year post-STN-DBS.
  • Lower baseline LEDD, greater axial impairment, and higher total volume of tissue activated were direct predictors of lower LEDD reduction.
  • Sensorimotor STN overlap positively correlated with motor improvement but not directly with LEDD reduction.

Conclusions:

  • Dopaminergic dose reduction post-STN-DBS is influenced by preoperative axial symptoms and stimulation spread, independent of motor gains.
  • Sensorimotor STN overlap enhances motor symptoms but does not directly impact medication reduction.
  • Integrating motor phenotype and anatomical factors may improve post-DBS medication management in Parkinson's disease.