Bilateral subthalamic nucleus stimulation in advanced Parkinson's disease: five year follow-up.

Abstract

OBJECTIVE:

To assess the long-term efficacy and safety of bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson's disease (PD).

METHODS:

42 consecutive patients with idiopathic PD treated with bilateral STN stimulation were enrolled. Parkinsonian status, medication intake and neuropsychological evaluation were assessed preoperatively and at 1 and 5 years postoperatively in on and off medication/on and off stimulation conditions.

RESULTS:

23 patients could be followed-up 5 years after surgery. In the remaining cases, 5 died, 1 could not be assessed because of device removal for infection, 1 decided not to be stimulated, and 11 were lost of follow-up (one because of a liver carcinoma and the others because they refused the formal four conditions of assessment). STN stimulation reduced the UPDRS motor score by 55 % compared to baseline in the off-medication conditions. Tremor, rigidity, bradykinesia, postural stability, and gait improved by 74 %, 66 %, 59 %, 17 % and 37 %, respectively. UPDRS part II scores were reduced by 38 %. The dopaminergic treatment daily dose was reduced by 54.4 % after surgery. Axial dopa-unresponsive signs worsened in some patients. Among the 42 initial patients we observed the following: 2 brain hemorrhages, 3 infections of the device, 2 phlebitis and 1 pulmonary embolism. In addition, 2 patients needed a repositioning of the electrode. Among the 23 patients followed at 5 years, long lasting side effects consisted in dysarthria (56 %), depression (39 %), eyelid opening apraxia (30.4 %) and apathy (4.3 %).

CONCLUSIONS:

Our data confirm that bilateral STN stimulation is beneficial in the long-term for PD patients but does not prevent disease progression and the occurence of axial levodopa unresponsive signs in some patients.

• Authors: Hélène Gervais-Bernard, Jing Xie-Brustolin, Patrick Mertens, Gustavo Polo, Hélène Klinger, Dario Adamec, Emmanuel Broussolle, Stéphane Thobois
• Journal: Journal of neurology (J Neurol) Vol. 256 Issue 2 Pg. 225-33 (Feb 2009) ISSN: 1432-1459 [Electronic] Germany
• PMID: 19242649 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antiparkinson Agents

Topics

• Adult
• Aged
• Antiparkinson Agents (administration & dosage)
• Blinking (drug effects, physiology)
• Deep Brain Stimulation (methods)
• Depressive Disorder (etiology)
• Disease Progression
• Dose-Response Relationship, Drug
• Drug Resistance
• Dysarthria (etiology)
• Female
• Follow-Up Studies
• Functional Laterality (physiology)
• Humans
• Male
• Middle Aged
• Outcome Assessment, Health Care (methods)
• Parkinson Disease (physiopathology, therapy)
• Subthalamic Nucleus (anatomy & histology, physiology)
• Time
• Time Factors
• Treatment Outcome