Background. Deep brain stimulation (DBS) has, for the most part, replaced irreversible stereotactic coagulations in the surgical treatment of advanced Parkinson’s disease. This study was undertaken to evaluate the benefits of bilateral STN stimulation related to its potential risks and side effects.
Method. Twenty-nine consecutive Parkinsonian patients treated with STN-DBS were prospectively followed-up. Effects on Parkinsonian symptoms were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS). The evaluation was performed preoperatively and included postoperative follow-up evaluations at one and twelve months. All evaluations were made during the patient’s best on-medication phase and postoperative follow-ups were conducted under both stimulator-on and stimulator-off conditions by a blinded neurologist. A neuropsychologist also evaluated the patients at every visit.
Findings. Two patients were excluded from the analysis because of severe surgical complications and three for an infection demanding the removal of the stimulator material. Other complications and side effects were clearly milder and temporary. At twelve months after surgery dyskinesia scores in the UPDRS were 53% lower than preoperative values. The results of the UPDRS motor scores improved 31.4% and activities of daily living (ADL) scores increased 19% compared with the preoperative situation. Also, the daily levodopa dose was 22% lower. Neuropsychological changes were minor, except for some deterioration in verbal fluency.
Conclusion. The majority of Parkinsonian patients experienced significant and long lasting relief from their motor symptoms and an improvement in ADL functions due to DBS-STN therapy when evaluated at the best on-medication phase.
Keywords: Parkinson’s disease; deep brain stimulation; subthalamic nucleus; motor symptoms; neuropsychology.
Alegret, M, Junqué, C, Valldeoriola, F, Vendrell, P, Milleri, M, Rumia, J, Tolosa, E 2001Effects of bilateral subthalamic stimulation on cognitive function in Parkinson’s disease.Arch Neurol5812231227CrossRefPubMedGoogle Scholar
Ardouin, C, Pillon, B, Peiffer, E, Bejjani, P, Limousin, P, Damier, P, Arnulf, R, Benabid, AL, Agid, Y, Pollak, P 1999Bilateral subthalamic or pallidal stimulation for Parkinson’s disease affects neither memory nor executive functions: a consecutive series of 62 patients.Ann Neurol46217223CrossRefPubMedGoogle Scholar
Benabid, AL, Krack, PP, Benazzouz, A, Limousin, P, Koudsie, A, Pollak, P 2000Deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: methodologic aspects and clinical criteria.Neurology554044Google Scholar
Benabid, AL 2002Inhibition of STN: where and how?Acta Neurochir (Wien)1441065Google Scholar
Bronte-Stewart, H 2003Parkinson’s disease: surgical options.Curr Treat Options Neurol5131147PubMedGoogle Scholar
Caparros-Lefebvre D, Blond S, N’Guyen JP, Pollak P, Benabid AL (1999) Chronic deep brain stimulation for movement disorders. In: Cohadon F et al (eds) Advances and technical standards in neurosurgery, vol 25. Springer Wien New York, pp 61–138Google Scholar
Charles, PD, van Blercom, N, Krack, P, Lee, SL, Xie, J, Besson, G, Benabid, AL, Pollak, P 2002Predictors of effective bilateral subthalamic nucleus stimulation for PD.Neurology59932934PubMedGoogle Scholar
Gibb, WR, Lees, AJ 1988The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease.J Neurol Neurosurg Psychiatry51745752PubMedCrossRefGoogle Scholar
Gordin, A, Kaakkola, S, Teräväinen, H 2003Position of COMT-inhibition in the treatment of Parkinson’s disease. Adv Neurology, vol 91.Lippincott Williams & WilkinsPhiladelphia237250Google Scholar
Haberler, C, Alesch, F, Mazal, PR, Pilz, P, Jellinger, K, Pinter, MM, Hainfellner, JA, Budka, H 2000No tissue damage by chronic deep brain stimulation in Parkinson’s disease.Ann Neurol48372376CrossRefPubMedGoogle Scholar
Hariz, MI, Bergenheim, AT, Fodstad, H 1999Crusade for microelectrode guidance in pallidotomy.J Neurosurg90175179PubMedGoogle Scholar
Houeto, JL, Damier, P, Bejjani, PB, Staedler, C, Bonnet, AM, Arnulf, I, Pidoux, B, Dormont, D, Cornu, P, Agid, Y 2000Subthalamic stimulation in Parkinson’s disease: a multidisclipinary approach.Arch Neurol57461465CrossRefPubMedGoogle Scholar
Krack, P, Benazzouz, A, Pollak, P, Limousin, P, Piallat, B, Hoffmann, D, Xie, J, Benabid, AL 1998Treatment of tremor in Parkinson’s disease by subthalamic nucleus stimulation.Mov Disord13907914PubMedGoogle Scholar
Krack, P, Fraix, V, Mendes, A, Benabid, AL, Pollak, P 2002Postoperative management of the subthalamic nucleus stimulation for Parkinson’s disease.Mov Disord17188197Google Scholar
Krack, P, Pollak, P, Limousin, P, Hoffman, D, Xie, J, Benazzous, A, Benabid, AL 1998Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson’s disease.Brain121451457CrossRefPubMedGoogle Scholar
Kumar, R, Lozano, AM, Kim, YJ, Hutchinson, WD, Sime, RN, Halket, E, Lang, AE 1998Double-blind evaluation of subthalamic deep brain stimuation in advanced Parkinson’s disease.Neurology51850855PubMedGoogle Scholar
Limousin, P, Krack, P, Pollak, P, Benazzous, A, Ardouin, C, Hoffmann, D, Benabid, AL 1998Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease.N Engl J Med33911051111CrossRefPubMedGoogle Scholar
Lopiano, L, Rizzone, M, Bergamasco, B, Tavella, A, Torre, E, Perozzo, P, Psychol, D, Valentini, MC, Lanotte, M 2001Deep brain stimulation of the subthalamic nucleus: clinical effectiveness and safety.Neurology56552554PubMedGoogle Scholar
Lozano, AM, Lang, AE, Galvez-Jimenez, N, Miyasaki, J, Duff, J, Hutchinson, WD 1995Effect of GPI pallidotomy on motor function in Parkinson’s disease.Lancet34613831387CrossRefPubMedGoogle Scholar
Moro, E, Scerrati, M, Romito, LMA, Roselli, R, Tonali, P, Albanese, A 1999Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease.Neurology538590PubMedGoogle Scholar
Molinuevo, JL, Valldeoriola, F, Tolosa, E, Rumia, J, Valls-Sole, J, Roldan, H, Ferrer, H 2000Levodopa withdrawal after bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease.Arch Neurol56552554Google Scholar
Østergaard, K, Sunde, N, Dupont, E 2002Effects of bilateral stimulation of the subthalamic nucleus in patients with severe Parkinson’s disease and motor fluctuations.Mov Disord17693700CrossRefPubMedGoogle Scholar
Pinter, MM, Alesch, F, Murg, M, Seiwald, M, Helscher, RJ, Binder, H 1999Deep brain stimulation of the subthalamic nucleus for control of extrapyramidal features in advanced idiopathic Parkinson’s disease: one year follow-up.J Neural Transm106693709PubMedGoogle Scholar
Reitan RM, Davison LA (1974) Clinical neuropsychology: current status and applications. Hemisphere, New York, NYGoogle Scholar
Spottke, EA, Volkmann, J, Lorenz, D, Krack, P, Smala, AM, Sturm, V, Gerstner, A, Berger, K, Hellwig, D, Deuschl, G, Freund, HJ, Oertel, WH, Dodel, RC 2002Evaluation of healthcare utilization and health status of patients with Parkinson’s disease treated with deep brain stimulation of the subthalamic nucleus.J Neurol249759766CrossRefPubMedGoogle Scholar
Tavella, A, Bergamasco, B, Bosticco, E, Lanotte, M, Perozzo, P, Rizzone, M, Torre, E, Lopiano, L 2002Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: long-term follow-up.Neurol Sci23111112CrossRefGoogle Scholar
The Deep-Brain Stimulation for Parkinson’s Disease Study Group2001Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease.N Engl J Med345956963CrossRefGoogle Scholar
Thobois, S, Corvaisier, S, Mertens, P, Di Guardo, C, Mollion, H, Guenot, M, Rochefort, F, Chazot, G, Sindou, M, Broussolle, E 2003The timing of antiparkinsonian treatment reduction after subthalamic nucleus stimulation.Eur Neurol495963CrossRefPubMedGoogle Scholar
Volkmann, J, Allert, N, Voges, J, Weiss, PH, Freund, HJ, Sturm, V 2001Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD.Neurology56548551PubMedGoogle Scholar
Wechsler D (1981) WAIS-R manual. The Psychological Corporation, San Antonio, TXGoogle Scholar
Wilding, IR, Hardy, JG, Davis, SS, Melia, CD, Evans, DF, Short, AH, Sparrow, RA, Yeh, KC 1991Characterisation of the in vivo behaviour of a controlled-release formulation of levodopa (Sinemet CR).Clin Neuropharmacol14305321PubMedGoogle Scholar
Woods, SP, Fields, JA, Tröster, AI 2002Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson’s disease: a critical review.Neuropsychol Rev12111126CrossRefPubMedGoogle Scholar