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Effects of subthalamic nucleus stimulation and levodopa on the autonomic nervous system in Parkinson’s disease
  1. Janne Ludwig1,
  2. Piet Remien1,
  3. Christoph Guballa1,
  4. Andreas Binder1,
  5. Sabine Binder2,
  6. Jörn Schattschneider1,
  7. Jan Herzog2,
  8. Jens Volkmann2,
  9. Günther Deuschl2,
  10. Gunnar Wasner1,
  11. Ralf Baron1
  1. 1Division of Neurological Pain Research and Therapy, University of Kiel, Kiel, Germany
  2. 2
  1. Correspondence to:
 Dr Janne Ludwig
 University of Schleswig Holstein, Campus Kiel, Division of Neurological Pain Research and Therapy, Department of Neurology, Schittenhelmstr 10, 24105 Kiel, Germany; j.ludwig{at}


Dysfunctions of the autonomic nervous system (ANS) are common in Parkinson’s disease (PD). Regarding motor disability, deep brain stimulation of the subthalamic nucleus (STN) is an effective treatment option in long lasting PD. The aims of this study were to examine whether STN stimulation has an influence on functions of the ANS and to compare these effects to those induced by levodopa.

Blood pressure (BP) and heart rate (HR) during rest and orthostatic conditions, HR variability (HRV) and breathing-induced cutaneous sympathetic vasoconstriction (CVC) were tested in 14 PD patients treated with STN stimulation during “ON” and “OFF” condition of the stimulator. The effects of a single dose of levodopa on ANS were tested in 15 PD patients without DBS.

STN stimulation had no influence on cardiovascular ANS functions, whereas CVC was significantly increased. In contrast, levodopa significantly lowered BP and HR at rest and enhanced orthostatic hypotension. Further, HRV, skin perfusion and temperature increased after administration of levodopa.

Our results suggest that in contrast to levodopa, STN stimulation has only minor effects on autonomic functions. Since less pharmacotherapy is needed after STN stimulation, reduced levodopa intake results in relative improvement of autonomic function in deep brain stimulated PD patients.

  • ANS, autonomic nervous system
  • BP, blood pressure
  • E/I ratio, expiration–inspiration ratio
  • HR, heart rate
  • HRV, heart rate variability
  • PD, Parkinson’s disease
  • STN-DBS, deep brain stimulation of the subthalamic nucleus

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  • Published Online First 19 March 2007

  • This work was supported by the Bundesministerium für Bildung und Forschung (BMBF, 01EM05/04), der Deutschen Forschungsgemeinschaft (DFG Ba1921/1-1/3) and der Alexander-von-Humboldt-Stiftung and Pfizer Deutschland (unrestricted educational grant). None of the sponsors was involved in the design or conduct of the study, or in the collection, management, analysis, interpretation or preparation of the data, or review or approval of the manuscript.

  • Competing interests: None.

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