Deep-brain stimulation boosts PD patients’ driving performance

By Eleanor McDermid, Senior medwireNews Reporter

Deep-brain stimulation (DBS) reduces errors among patients with Parkinson’s disease (PD) undergoing a driving simulator test, a study shows.

“Our data support the hypothesis that DBS has no negative but rather a beneficial effect on driving in patients with PD,” say Carsten Buhmann and team from University Medical Center Hamburg-Eppendorf in Germany.

In a simulated 1.7 km urban driving course, 23 PD patients with DBS were as accurate as 21 controls without PD matched for age, gender, cognition, and driving experience. They completed the course significantly more slowly, at an average of 252 versus 159 seconds, but made no more driving errors of any severity, and actually made significantly fewer slight errors.

The researchers describe the comparable performances as “unexpected.” However, they note that the course, although demanding, was short, and driving over longer distances could be impaired in PD patients because of problems with sustained attention. “Therefore, the present results might be limited to shorter driving distances, such as inner-city or neighborhood driving,” they write in Neurology.

By contrast, 21 matched PD patients without DBS had significantly more inaccurate driving time than controls, and made significantly more errors than both controls and patients with DBS, at an average of 18.0 versus 11.3 and 10.7, respectively. They completed the course in an intermediate time, averaging 199 seconds.

When patients with DBS were tested with stimulation switched off, their driving speed did not alter, but they made significantly more errors, at 14.2 versus 11.0, on average. When given a dose of levodopa that brought their motor function in line with that achieved by DBS, they made fewer errors, but still significantly more than controls, at an average of 12.9.

Buhmann et al say the poorer performance with levodopa “might be partly explained by the inverted U-shape relationship between dopamine and cognition,” or by levodopa-related impulsivity.

The researchers conclude that “regaining a better driving ability in PD might be one aspect of improved quality of life with DBS in comparison to medical treatment alone.” But they add that further study of longer-distance driving is needed.

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