British Journal of Nutrition

Research Article

Effects of subthalamic nucleus deep brain stimulation and levodopa on energy production rate and substrate oxidation in Parkinson's disease

Caroline Perlemoinea1 c1, Frédéric Maciaa2, François Tisona2, Isabelle Comana2, Dominique Guehla2, Pierre Burbauda2, Emmanuel Cunya3, Laurence Bailleta1, Henri Gina1 and Vincent Rigalleaua1

a1 Service de Nutrition-Diabétologie, Hôpital Haut-Lévêque, Avenue Magellan, 33600 Pessac, France

a2 Service de Neurologie, Hôpital Haut-Lévêque, Pessac, France

a3 Service de Neurochirurgie, Hôpital du Tripode, Bordeaux, France

Abstract

Patients with Parkinson's disease (PD) often lose weight, but after subthalamic nucleus deep brain stimulation (STN-DBS), they gain weight. We compared daily energy intake (DEI), resting energy expenditure (REE) and substrate oxidation rates (measured by indirect calorimetry) in nineteen STN-DBS-treated patients (Group S), thirteen others on pharmacologic treatment by levodopa (Group L) and eight control subjects. We also determined the acute effects of STN-DBS and levodopa on REE and substrate oxidation rates. STN-DBS treated patients gained 9·7 (sem 7·1) kg after surgery, whereas patients on pharmacologic treatment lost 3·8 (sem 10·0) kg since diagnosis. In STN-DBS-treated patients, REE (−16·5 %; P<0·001), lipid oxidation (−27 %; P<0·05) and protein oxidation (−46 %; P<0·05) were decreased, whereas glucose oxidation was elevated (+81 %; P<0·05) as compared to patients on pharmacologic treatment. Levodopa acutely reduced REE (−8·3 %; P<0·05) and glucose oxidation (−37 %; P<0·01) with a slight hyperglycaemic effect (after levodopa challenge: 5·6 (sem 0·8) v. before levodopa challenge: 5·3 (sem 0·6) mmol/l; P<0·01). Switching ‘on’ STN-DBS acutely reduced REE (−17·5 %; P<0·01) and lipid oxidation (−24 %; P<0·001) 30 min after starting stimulation. Fasting glycaemia was slightly but significantly reduced (5·4 (sem 1·4) v. 5·5 (sem 1·3) mmol/l; P<0·01). After STN-DBS, the normalization of REE and the reduction in lipid and protein oxidation contribute to the restoration of weight. As levodopa decreases glucose oxidation, the reduction in daily dose of levodopa in STN-DBS-treated patients helps prevent the effect of weight gain on glycaemia.

(Received May 17 2004)

(Revised August 09 2004)

(Accepted September 04 2004)

Correspondence:

c1 Corresponding author: Dr Caroline Perlemoine, fax +33 0557656484, email caroline.perlemoine@chu-bordeaux.fr

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