Dyskinesias and grip control in Parkinson's disease are normalized by chronic stimulation of the subthalamic nucleus

Abstract

Deep‐brain stimulation of the subthalamic nucleus appears to reduce levodopa‐induced dyskinesias, but whether this effect is caused by the reduction of the total levodopa ingestion or represents a direct effect on the motor system is unknown. Precision grip force of grasping movements and levodopa‐induced dyskinesias was analyzed in 10 parkinsonian patients before and after 3 months of deep‐brain stimulation of the subthalamic nucleus. Peak grip force was abnormally increased before surgery in the off‐drug state and, particularly, in the on‐drug state (sensitization). This grip force upregulation normalized with chronic deep‐brain stimulation in both conditions (desensitization). Peak‐dose dyskinesias also improved, and off‐dystonia was completely abolished. Mean dosage of dopaminergic drugs was reduced, but force overflow and dyskinesias were equally improved in 2 patients without a reduction. Despite the same single levodopa test dose, force excess and levodopa‐induced dyskinesias were drastically reduced after 3 months of deep‐brain stimulation of the subthalamic nucleus. This indicates that direct effects of deep‐brain stimulation of the subthalamic nucleus on levodopa‐induced dyskinesias are likely to occur. Grip force overflow is a promising parameter to study the desensitizing effect of chronic deep‐brain stimulation on levodopa‐induced dyskinesias.