2). Additionally, subjects who underwent staged bilateral surgery within 2 years of their original surgery had an average duration of IKK Inhibitor VII supplier disease of 2 years longer than the unilateral STN DBS patients prior to surgery. These findings suggest that simple measures such as body weight and duration of disease may capture aspects of PD disability that are not as clearly reflected in clinical rating scales. Coupling our findings with other studies in patients with PD,

these data are consistent with progressive weight loss over time in PD patients following diagnosis (Chen et al. 2003). Figure 2 Distribution of body mass index (BMI) at the time of surgery (baseline) and at 24 months Inhibitors,research,lifescience,medical postoperatively. Patients who underwent staged STN DBS within the 24-month period were more Inhibitors,research,lifescience,medical likely to be clinically underweight by NHLBI BMI criteria. A strength of this study is that a relatively large number of DBS patients and controls without DBS were followed for 2 years after placement of the initial STN electrode. Additionally, within-subject comparisons of weight over time diminished Inhibitors,research,lifescience,medical intersubject variance. A potential limitation of this study is that the participants were not randomized to unilateral DBS, staged bilateral DBS, or medical therapy alone, and the decision to undergo staged bilateral

procedure was driven by clinical necessity. Although these considerations might introduce bias into the results because of underlying differences in PD phenotype, disease severity, or other factors, we attempted to minimize such potential confounds by controlling for disease severity, duration of disease, dose of dopaminergic medications, age, and gender. Regardless, our findings Inhibitors,research,lifescience,medical are reported from DBS

patients in real-world movement disorders practice, which could increase the generalizability of our results to other clinical settings. The mechanisms underlying Inhibitors,research,lifescience,medical changes in weight in PD patients with and without DBS have been a matter of debate. In PD patients without DBS, weight loss may result from increased energy expenditure Bumetanide from motor symptoms, decreased caloric intake because of motor disability, and/or changes in central appetite mechanisms from medications or from PD itself (Montaurier et al. 2007). Although the mechanism for weight gain following STN DBS is also likely multifactorial, several studies argue for reduction of motor symptoms playing a significant role in postoperative weight gain. Rigidity, tremor, and bradykinesia associated with PD are relieved within seconds to minutes following activation of STN DBS at therapeutic settings (Moro et al. 2002). Calorimetric studies show similar temporal dynamics, with bilateral STN DBS decreasing the basal energy expenditure within minutes after starting therapeutic stimulation (Montaurier et al. 2007).