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.
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 PDpatients but does not prevent disease progression and the occurence of axial levodopa unresponsive signs in some patients.
Authors: Galit Kleiner-Fisman; Jan Herzog; David N Fisman; Filippo Tamma; Kelly E Lyons; Rajesh Pahwa; Anthony E Lang; Günther Deuschl Journal: Mov Disord Date: 2006-06 Impact factor: 10.338
Authors: M C Rodriguez-Oroz; J A Obeso; A E Lang; J-L Houeto; P Pollak; S Rehncrona; J Kulisevsky; A Albanese; J Volkmann; M I Hariz; N P Quinn; J D Speelman; J Guridi; I Zamarbide; A Gironell; J Molet; B Pascual-Sedano; B Pidoux; A M Bonnet; Y Agid; J Xie; A-L Benabid; A M Lozano; J Saint-Cyr; L Romito; M F Contarino; M Scerrati; V Fraix; N Van Blercom Journal: Brain Date: 2005-06-23 Impact factor: 13.501
Authors: J L Houeto; V Mesnage; L Mallet; B Pillon; M Gargiulo; S Tezenas du Moncel; A M Bonnet; B Pidoux; D Dormont; P Cornu; Y Agid Journal: J Neurol Neurosurg Psychiatry Date: 2002-06 Impact factor: 10.154
Authors: Frances M Weaver; Kenneth A Follett; Matthew Stern; Ping Luo; Crystal L Harris; Kwan Hur; William J Marks; Johannes Rothlind; Oren Sagher; Claudia Moy; Rajesh Pahwa; Kim Burchiel; Penelope Hogarth; Eugene C Lai; John E Duda; Kathryn Holloway; Ali Samii; Stacy Horn; Jeff M Bronstein; Gatana Stoner; Philip A Starr; Richard Simpson; Gordon Baltuch; Antonio De Salles; Grant D Huang; Domenic J Reda Journal: Neurology Date: 2012-06-20 Impact factor: 9.910