Lower Urinary Tract Symptoms and Bladder Control in Advanced Parkinson’s Disease: Effects of Deep Brain Stimulation in the Subthalamic Nucleus.
Winge, K., Kroyer Nielsen, K., Stimple, H., Lokkegaard, A., Jensen, S. and Werdelin, L Lower Urinary Tract Symptoms and Bladder Control in Advanced Parkinson’s Disease: Effects of Deep Brain Stimulation in the Subthalamic Nucleus. , Movement Disorders 2007, 22(2), 220-225.
This article was a prospective study looking at the short-term effects of DBS STN on problematic bladder symptoms commonly seen in patients with PD. These bladder problems are often due to the disease or medication side effects. This study looked at patient’s report as well as direct measurement of bladder function prior to surgery and within 6 months after surgery. Patients had improvement in their motor symptoms (UPDRS motor score and dyskinesia) and in overactive bladder symptoms. However, they found that patients report of being “bothered by” their bladder symptoms initially decreased but then worsened as time went on after DBS STN. Two possibilities explain the increase in patient report of worsened symptoms at the 6 month point. The first possibility is that patients may have had such improvement in their motor symptoms due to surgery that previously less bothersome symptoms (e.g. nonmotor symptoms) are more evident. The second possibility is that DBS STN had worsened the way people cope with their illness or situation. It is difficult to say which possibility best explains the decline, as there is not much research on changes in coping strategies as PD progresses. This study is in direct contrast to two other studies mentioned on our site (Finazzi-Agro et al. & Seif et al.), but the participants in the current study and the time since the DBS surgery was different. The authors of this study only looked at bladder problems up to 6 months after DBS STN, whereas the other studies looked at long-term bladder dysfunction (both studies showed significant improvement). This suggests that with time DBS STN likely has a beneficial effect on the bladder functioning, but that it may not be as evident within the first six months after surgery. The ideal study would look at both short term and long term gain in bladder function before and after DBS STN, which has yet to be done in the literature.