Parkinson's Insights

Stop being a passenger, drive your own care with a holistic approach to Parkinson's.

Can DBS steady the hidden storms of autonomic symptoms in Parkinson's? MAYBE. Autonomic symptoms are the automatic body functions that regulate blood pressure, gut motility, bladder control, sweating and breathing. They run 'in the background' w/out conscious effort. John Chen and colleagues describe in a new paper in Movement Disorders Clinical Practice how they systematically mapped what is known about the effects of deep brain stimulation on autonomic symptoms in Parkinson across multiple organ systems. Key Points: - DBS effects on gut and heart symptoms show the most promise. - STN DBS can improve certain gastrointestinal symptoms such as constipation and delayed gastric emptying and may ease cardiovascular issues like orthostatic intolerance in some cohorts. - Results are unfortunately not consistent across all studies. - Urinary, sweating and breathing effects are mixed and understudied. - Urinary problems, thermoregulatory symptoms such as excessive sweating and respiratory complaints show highly variable responses. - The core problem in interpretation is that the 57 studies had 1960 DBS folks however they employed used different scales, different follow up times and different targets. My take: DBS can definitely impact autonomic symptoms, both in the positive and negative direction. The response is not easily predictable, and likely has a lot to do w/ DBS lead location. Here are 5 points that resonated w/ me: 1- Autonomic symptoms matter as much as tremor and slowness. 2- DBS may help constipation and lightheadedness for some folks. 3- Do not expect DBS to be a cure for all body system issues. 4- How and where we stimulate likely matters a great deal. Early work suggests that small changes in lead location and stimulation settings may shift outcomes for gut, heart or bladder symptoms. 5- We could use some focused trials for autonomic health. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.70429 #michaelokun #fixelinstitute #parkinson #dbs #deepbrainstimulation

November 20, 2025

@michaelokun

Can DBS steady the hidden storms of autonomic symptoms in Parkinson's? MAYBE. Autonomic symptoms are the automatic body functions that regulate blood pressure, gut motility, bladder control, sweating and breathing. They run 'in the background' w/out conscious effort. John Chen and colleagues describe in a new paper in Movement Disorders Clinical Practice how they systematically mapped what is known about the effects of deep brain stimulation on autonomic symptoms in Parkinson across multiple organ systems. Key Points: - DBS effects on gut and heart symptoms show the most promise. - STN DBS can improve certain gastrointestinal symptoms such as constipation and delayed gastric emptying and may ease cardiovascular issues like orthostatic intolerance in some cohorts. - Results are unfortunately not consistent across all studies. - Urinary, sweating and breathing effects are mixed and understudied. - Urinary problems, thermoregulatory symptoms such as excessive sweating and respiratory complaints show highly variable responses. - The core problem in interpretation is that the 57 studies had 1960 DBS folks however they employed used different scales, different follow up times and different targets. My take: DBS can definitely impact autonomic symptoms, both in the positive and negative direction. The response is not easily predictable, and likely has a lot to do w/ DBS lead location. Here are 5 points that resonated w/ me: 1- Autonomic symptoms matter as much as tremor and slowness. 2- DBS may help constipation and lightheadedness for some folks. 3- Do not expect DBS to be a cure for all body system issues. 4- How and where we stimulate likely matters a great deal. Early work suggests that small changes in lead location and stimulation settings may shift outcomes for gut, heart or bladder symptoms. 5- We could use some focused trials for autonomic health. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.70429 #michaelokun #fixelinstitute #parkinson #dbs #deepbrainstimulation

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