Top

Published in:

01-12-2009 | Original Communication

Modulation of nutritional state in Parkinsonian patients with bilateral subthalamic nucleus stimulation

Authors: Joana Guimarães, Eduarda Matos, Maria José Rosas, Augusta Vieira-Coelho, Nuno Borges, Flora Correia, Rui Vaz, Carolina Garrett

Published in: Journal of Neurology | Issue 12/2009

Abstract

Chronic bilateral subthalamic stimulation (DBS-STN) provides considerable clinical benefits in Parkinson disease patients, with improvement in primary symptoms and resolution of side effects of chronic pharmacological treatment. Apart from its therapeutic effects on PD symptoms, DBS-STN also appears to induce weight gain, which may itself induce critical metabolic disorders and limit the benefits of surgery. No data are available in literature showing the efficacy of a nutritional intervention to prevent rapid and/or excessive weight gain after DBS-STN. Fifty-seven PD patients were included in this study and were divided into two groups: Group 1 comprised 16 patients with a nutritional intervention immediately after surgery (1 week after); Group 2 comprised 41 patients with a nutritional intervention in a later period after surgery (mean time of 2.5 ± 1.6 years). Weight, body mass index (BMI), percentage of fat mass, levodopa daily dose (LDD) and part III of the Unified Parkinson’s disease rating scale (UPDRS) were studied before and after an individualized and structured nutritional intervention. Three months after nutritional intervention, Group 1 had a mean BMI (24.1 ± 2.99), that was not significantly different (p = 0.114) from BMI before intervention, with stability of the weight and in percentage of fat mass. In Group 2 all the patients gained weight, reaching to 13.17 ± 10%; a total of 63% of patients became overweight (BMI 25 kg/m²). Three months after nutritional intervention, Group 2 had a mean BMI (24.80 ± 2.45) that was significantly (p = 0.03) different from BMI before intervention (26.75 ± 2.99), although percentage of fat mass was higher in women. With this study, we have conclude that nutritional intervention adequate to patient-age, disease characteristics, medical therapy with l-dopa and physical activity, is effective incontrolling weight after DBS-STN surgery.

Volkmann J, Albert N, Voges J, Weiss PH, Freund HJ, Sturm V (2001) Safety and efficacy of pallidal and subthalamic nucleus stimulation in advanced PD. Neurology 56:548–551PubMed

Anheim M, Batir A, Fraix V, Silem M, Chabardès S, Seigneuret E (2008) Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. Arch Neurol 65(5):612–616CrossRefPubMed

Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P, Rehncrona S et al (2005) Brain bilateral deep brain stimulation in Parkinson’s disease a multicentre study with 4 years follow-up. Brain 128(Pt 10):2240–2249CrossRefPubMed

Schüpbach WM, Chastan N, Welter ML, Houeto JL, Mesnage V, Bonnet AM et al (2005) Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5-year follow up. J Neurol Neurosurg Psychiatry 76(12):1640–1644CrossRefPubMed

Gironell A, Pascual-Sedano B, Otermin P, Kulisevsky J (2002) Weight gain after functional surgery for Parkinson’s disease. Neurologia 17:310–316PubMed

Barichella M, Marczewska AM, Mariani C, Landi A, Vairo A, Pezzoli G (2003) Body weight gain rate in patients with Parkinson’s disease and deep brain stimulation. Mov Disord 18:1337–1340CrossRefPubMed

Macia F, Perlemoine C, Coman I, Guehl D, Burbaud P, Cuny E et al (2004) Parkinson’s disease patients with bilateral subthalamic deep brain stimulation gain weight. Mov Disord 19(2):206–212CrossRefPubMed

Tuite PJ, Maxwell RE, Ikramuddin S, Kotz CM, Billington CJ, Laseski MA et al (2005) Weight and body mass index in Parkinson’s disease patients after deep brain stimulation surgery. Parkinsonism Relat Disord 11(4):247–252CrossRefPubMed

Perlemoine C, Macia F, Tison F, Coman I, Guehl D, Burbaud P et al (2005) Effects of subthalamic nucleus deep brain stimulation and l-dopa on energy production rate and substrate oxidation in Parkinson’s disease. Br J Nutr 93:191–198CrossRefPubMed

10.

Montaurier C, Morio B, Bannier S, Derost P, Arnaud P, Brandolini-Bunlon M et al (2007) Mechanisms of body weight gain in patients with Parkinson’s disease after subthalamic stimulation. Brain 130(7):1808–1818CrossRefPubMed

11.

Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB (2002) Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 16:7–1872

12.

Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289(1):76–79

13.

Cuny E, Guehl D, Burbaud P, Gross C, Dousset V, Rougier A (2002) Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance. J Neurosurg 97:591–597CrossRefPubMed

14.

Consensus Conference Proceedings (2000) Parkinson’s disease: diagnostic and therapeutic criteria. Rev Neurol (Paris) 156:7–294

15.

Elia M, Ward LC (1999) New techniques in nutritional assessment: body composition methods. Proc Nutr Soc 58(1):33–38CrossRefPubMed

16.

Siri W (1961) Body composition from fluid spaces and density: analyses of methods. National Academic of Sciences, Washington

17.

Durnin JV, Womersley J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32(1):77–97CrossRefPubMed

18.

Metropolitan height and weight tables (1983) Stat Bull Metrop Life Found 64(1):3–9

19.

FAO/OMS. Rapport d’un comité spécial mixte FAO/OMS d’experts. Besoins énergétiques et besoins en protéines. Série de Rapports techniques; 1973:522

20.

Bagnasco M, Dube MG, Kalra PS (2002) Evidence for the existence of distinct central appetite, energy expenditure, and ghrelin stimulation pathways as revealed by hypothalamic site-specific leptin gene therapy. Endocrinology 143(11):4409–4421CrossRefPubMed

21.

Langston JW, Forno LS (1978) The hypothalamus in Parkinson disease. Ann Neurol 3:129–133CrossRefPubMed

22.

Lipp A, Tank J, Trottenberg T, Kupsch A, Arnold G, Jordan J (2005) Sympathetic activation due to deep brain stimulation in the region of the STN. Neurology 65:774–775CrossRefPubMed

23.

Liu LL, Li BM, Yang J, Wang YW (2008) Does dopaminergic reward system contribute to explaining comorbidity obesity and ADHD? Med Hypotheses 70(6):1118–1120CrossRefPubMed

24.

Wang GJ, Volkow ND, Logan J, Pappas NR, Wong CT, Zhu W, Netusil N, Fowler JS (2001) Brain dopamine and obesity. Lancet 357:354–357CrossRefPubMed

25.

Simon N, Gantcheva R, Bruguerolle B, Viallet F (2004) The effects of a normal protein diet on levodopa kinetics in advanced Parkinson’s disease. Parkinsonism Relat Disord 10:137–142CrossRefPubMed

26.

Bracco MalesaniR, Saladani M (1991) Protein redistribution diet and antiparkinsonian response to levodopa. Eur Neurol 31(2):68–71CrossRefPubMed

27.

Berry EM, Growdon JH, Wurtman JJ, Caballero B, Wurtman RJ (1991) A balanced carbohydrate: protein diet in the management of Parkinson’s disease. Neurology 41:1295–1297PubMed

28.

Stamler J, Neaton JD (2008) The multiple risk factor intervention trial (MRFIT)—importance then and now. JAMA 300(11):1343–1345CrossRefPubMed

Title: Modulation of nutritional state in Parkinsonian patients with bilateral subthalamic nucleus stimulation
Authors: Joana Guimarães
Eduarda Matos
Maria José Rosas
Augusta Vieira-Coelho
Nuno Borges
Flora Correia
Rui Vaz
Carolina Garrett
Publication date: 01-12-2009
Publisher: D. Steinkopff-Verlag
Published in: Journal of Neurology / Issue 12/2009
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-009-5252-x

At a glance: The STEP trials

Springer Medicine

Modulation of nutritional state in Parkinsonian patients with bilateral subthalamic nucleus stimulation

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2009

Two cases of benign neuromyelitis optica in patients with celiac disease

Postpartum relapsing sensory neuritis responsive to intravenous immunoglobulin

Erratum to: Alzheimer’s disease, but not ageing or depression, affects dual-tasking

Charcot–Marie–Tooth disease type 2J with MPZ Thr124Met mutation: clinico-electrophysiological and MRI study of a family

Optic neuritis presenting with amaurosis fugax

Frequency of progranulin mutations in a German cohort of 79 frontotemporal dementia patients