Skip to main content
SpringerLink
Log in

Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson’s disease: one year follow-up of a randomised observer-blind multi centre trial

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Background. To investigate whether STN stimulation is more efficacious than unilateral pallidotomy in advanced Parkinson’s disease (PD) one year after surgery.

Method. Thirty-four patients with advanced PD were randomly assigned to unilateral pallidotomy or bilateral STN stimulation. Outcome measures were parkinsonian symptoms in off and on phases (UPDRS 3), dyskinesias, functional status, Parkinson’s disease quality of life questionnaire, the effects on separate symptoms, timed tests, patient diaries, dopaminergic drugs changes, adverse effects, and global outcome scale. Patients were assessed before surgery, six months and one year after surgery. The primary outcome measure was the off phase UPDRS 3 at six months follow-up.

Findings. The off phase UPDRS 3 score improved from 46.5 to 32 points in the pallidotomy patients and from 51.5 to 24 in the STN stimulation patients (p = 0.002). On phase UPDRS 3 and off phase Schwab and England functional scale improved significantly in favour of the STN stimulation patients. Dopaminergic drugs reduction was larger in the STN group although the difference between the treatment groups was not significant. One patient in each group had a major adverse effect.

Conclusions. Bilateral STN stimulation is more efficacious than unilateral pallidotomy in advanced PD up to one year after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • LV Laitinen AT Bergenheim MI Hariz (1992) ArticleTitleLeksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease J Neurosurg 76 53–61 Occurrence Handle1727169 Occurrence Handle1:STN:280:DyaK38%2FnvFSnsA%3D%3D Occurrence Handle10.3171/jns.1992.76.1.0053

    Article  PubMed  CAS  Google Scholar 

  • AE Lang AM Lozano EB Montgomery J Duff RR Tasker WD Hutchinson (1997) ArticleTitlePosteroventral medial pallidotomy in advanced Parkinson’s disease N Engl J Med 337 1036–1042 Occurrence Handle9321531 Occurrence Handle1:STN:280:DyaK2svkvFSksw%3D%3D Occurrence Handle10.1056/NEJM199710093371503

    Article  PubMed  CAS  Google Scholar 

  • RMA de Bie RJ de Haan PCG Nijssen AWF Rutgers GN Beute DA Bosch R Haaxma B Schmand PR Schuurman MJ Staal JD Speelman (1999) ArticleTitleUnilateral pallidotomy in Parkinson’s disease: a randomised, single-blind, multicentre trial Lancet 354 1665–1669 Occurrence Handle10568567 Occurrence Handle1:STN:280:DC%2BD3c%2Fjtlaitw%3D%3D Occurrence Handle10.1016/S0140-6736(99)03556-4

    Article  PubMed  CAS  Google Scholar 

  • P Limousin P Krack P Pollak A Benazzouz C Ardouin D Hoffmann AL Benabid (1998) ArticleTitleElectrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease N Engl J Med 339 1105–1111 Occurrence Handle9770557 Occurrence Handle1:STN:280:DyaK1cvjt1Cmsg%3D%3D Occurrence Handle10.1056/NEJM199810153391603

    Article  PubMed  CAS  Google Scholar 

  • InstitutionalAuthorNameThe Deep-Brain Stimulation For Parkinson’s Disease Study Group (2001) ArticleTitleDeep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease N Engl J Med 345 956–963 Occurrence Handle10.1056/NEJMoa000827

    Article  Google Scholar 

  • RAJ Esselink RM de Bie RJ de Haan MWPM Lenders PCG Nijssen MJ Staal HMM Smeding PR Schuurman DA Bosch JD Speelman (2004) ArticleTitleUnilateral pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson’s disease: a randomised, observer-blind, multi-centre trial Neurology 62 201–207 Occurrence Handle14745054 Occurrence Handle1:STN:280:DC%2BD2c%2FksVyjtw%3D%3D

    PubMed  CAS  Google Scholar 

  • DJ Gelb E Oliver S Gilman (1999) ArticleTitleDiagnostic criteria for Parkinson disease Arch Neurol 56 33–39 Occurrence Handle9923759 Occurrence Handle1:STN:280:DyaK1M7itVKgtg%3D%3D Occurrence Handle10.1001/archneur.56.1.33

    Article  PubMed  CAS  Google Scholar 

  • MM Hoehn MD Yahr (1967) ArticleTitleParkinsonism: onset, progression and mortality Neurology 17 427–442 Occurrence Handle6067254 Occurrence Handle1:STN:280:DyaF2s7jvFSgsg%3D%3D Occurrence Handle10.1159/000137111

    Article  PubMed  CAS  Google Scholar 

  • S Mattis (1976) Mental status examination for organic mental syndrome in the elderly patient L Bellak TB Karasu (Eds) Geriatric psychiatry: a handbook for psychiatrists and primary care physicians Grune & Stratton New York 77–121

    Google Scholar 

  • S Fahn RL Elton InstitutionalAuthorNameMembers of the UPDRS Development Committee (1987) Unified Parkinson’s disease rating scale S Fahn CD Marsden DB Calne (Eds) Recent developments in Parkinson’s disease Macmillan Healthcare Information Florham Park, NJ 153–163

    Google Scholar 

  • P Hagell H Widner (1999) ArticleTitleClinical rating of dyskinesias in Parkinson’s disease: use and reliability of a new rating scale Mov Disord 14 448–455 Occurrence Handle10348468 Occurrence Handle1:STN:280:DyaK1M3ns1ahtg%3D%3D Occurrence Handle10.1002/1531-8257(199905)14:3<448::AID-MDS1010>3.0.CO;2-0

    Article  PubMed  CAS  Google Scholar 

  • AGEM de Boer W Wijker JD Speelman JCJM de Haes (1996) ArticleTitleQuality of life in patients with Parkinson’s disease: development of a questionnaire J Neurol Neurosurg Psychiatry 61 70–74 Occurrence Handle8676165 Occurrence Handle1:STN:280:DyaK283ns1eluw%3D%3D Occurrence Handle10.1136/jnnp.61.1.70

    Article  PubMed  CAS  Google Scholar 

  • G-L Defer H Widner RM Marié P Remy M Levivier (1999) ArticleTitleCore assessment program for surgical interventional therapies in Parkinson’s disease (CAPSIT-PD) Mov Disord 14 572–584 Occurrence Handle10435493 Occurrence Handle1:STN:280:DyaK1MzmtFyntA%3D%3D Occurrence Handle10.1002/1531-8257(199907)14:4<572::AID-MDS1005>3.0.CO;2-C

    Article  PubMed  CAS  Google Scholar 

  • de Bie PR Schuurman DA Bosch RJ de Haan B Schmand JD Speelman (2001) ArticleTitleOutcome of unilateral pallidotomy in advanced Parkinson’s disease: Cohort study of 32 patients J Neurol Neurosurg Psychiatry 71 375–382 Occurrence Handle11511714 Occurrence Handle1:STN:280:DC%2BD3Mvms12gtw%3D%3D Occurrence Handle10.1136/jnnp.71.3.375

    Article  PubMed  CAS  Google Scholar 

  • R Kumar AM Lozano E Sime E Halket AE Lang (1999) ArticleTitleComparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation Neurology 53 561–566 Occurrence Handle10449121 Occurrence Handle1:STN:280:DyaK1Mzns1elsw%3D%3D

    PubMed  CAS  Google Scholar 

  • J Volkmann N Allert J Voges PH Weiss H-J Freund V Sturm (2001) ArticleTitleSafety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD Neurology 56 548–551 Occurrence Handle11222806 Occurrence Handle1:STN:280:DC%2BD3M7ps1Knsw%3D%3D

    PubMed  CAS  Google Scholar 

  • PD Charles N Van Blercom P Krack SL Lee J Xie G Besson AL Benabid P Pollak (2002) ArticleTitlePredictors of effective bilateral subthalamic nucleus stimulation for PD Neurology 59 932–934 Occurrence Handle12297584 Occurrence Handle1:STN:280:DC%2BD38vos1eksg%3D%3D

    PubMed  CAS  Google Scholar 

  • P Krack A Batir N Van Blercom S Chabardes V Fraix C Ardouin A Koudsie P Dowsey Limousin A Benazzouz JF Le Bas AL Benabid P Pollak (2003) ArticleTitleFive-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease N Engl J Med 349 1925–1934 Occurrence Handle14614167 Occurrence Handle1:CAS:528:DC%2BD3sXptVGnurk%3D Occurrence Handle10.1056/NEJMoa035275

    Article  PubMed  CAS  Google Scholar 

  • JL Houeto P Damier BP Bejjani C Staedler AM Bonnet I Arnulf B Pidoux D Dormont P Cornu Y Agid (2000) ArticleTitleSubthalamic stimulation in Parkinson’s disease: a multidisciplinary approach Arch Neurol 57 461–465 Occurrence Handle10768618 Occurrence Handle1:STN:280:DC%2BD3c3ivFWjtw%3D%3D Occurrence Handle10.1001/archneur.57.4.461

    Article  PubMed  CAS  Google Scholar 

  • V Fraix JL Houeto C Lagrange PC Le P Krystkowiak D Guehl C Ardouin ML Welter F Maurel L Defebvre A Rougier AL Benabid V Mesnage M Ligier S Blond P Burbaud B Bioulac A Destee P Cornu P Pollak (2006) ArticleTitleClinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson’s disease J Neurol Neurosurg Psychiatry 77 443–449 Occurrence Handle16543519 Occurrence Handle1:STN:280:DC%2BD287lsVWnuw%3D%3D Occurrence Handle10.1136/jnnp.2005.077677

    Article  PubMed  CAS  Google Scholar 

  • W Meissner D Schreiter J Volkmann T Trottenberg GH Schneider V Sturm G Deuschl A Kupsch (2005) ArticleTitleDeep brain stimulation in late stage Parkinson’s disease: a retrospective cost analysis in Germany J Neurol 252 218–223 Occurrence Handle15729530 Occurrence Handle10.1007/s00415-005-0640-3

    Article  PubMed  Google Scholar 

  • A Funkiewiez C Ardouin P Krack V Fraix N Van Blercom J Xie E Moro AL Benabid P Pollak (2003) ArticleTitleAcute psychotropic effects of bilateral subthalamic nucleus stimulation and levodopa in Parkinson’s disease Mov Disord 18 524–530 Occurrence Handle12722166 Occurrence Handle10.1002/mds.10441

    Article  PubMed  Google Scholar 

  • HM Smeding JD Speelman M Koning-Haanstra PR Schuurman P Nijssen T van Laar B Schmand (2006) ArticleTitleNeuropsychological effects of bilateral STN stimulation in Parkinson disease: a controlled study Neurology 66 1830–1836 Occurrence Handle16801645 Occurrence Handle1:STN:280:DC%2BD28zosFGqug%3D%3D Occurrence Handle10.1212/01.wnl.0000234881.77830.66

    Article  PubMed  CAS  Google Scholar 

  • WM Schupbach N Chastan ML Welter JL Houeto V Mesnage AM Bonnet V Czernecki D Maltete A Hartmann L Mallet B Pidoux D Dormont S Navarro P Cornu A Mallet Y Agid (2005) ArticleTitleStimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up J Neurol Neurosurg Psychiatry 76 1640–1644 Occurrence Handle16291886 Occurrence Handle1:STN:280:DC%2BD2MnjsVKmsg%3D%3D Occurrence Handle10.1136/jnnp.2005.063206

    Article  PubMed  CAS  Google Scholar 

  • VC Anderson KJ Burchiel P Hogarth J Favre JP Hammerstad (2005) ArticleTitlePallidal vs subthalamic nucleus deep brain stimulation in Parkinson’s disease Arch Neurol 62 554–560 Occurrence Handle15824252 Occurrence Handle10.1001/archneur.62.4.554

    Article  PubMed  Google Scholar 

  • P Krack P Pollak P Limousin D Hoffmann J Xie A Benazzouz AL Benabid (1998) ArticleTitleSubthalamic nucleus or internal pallidal stimulation in young onset Parkinson’s disease Brain 121 451–457 Occurrence Handle9549521 Occurrence Handle10.1093/brain/121.3.451

    Article  PubMed  Google Scholar 

  • MC Rodriguez-Oroz JA Obeso AE Lang JL Houeto P Pollak S Rehncrona J Kulisevsky A Albanese J Volkmann MI Hariz NP Quinn JD Speelman J Guridi I Zamarbide A Gironell J Molet B Pascual-Sedano B Pidoux AM Bonnet Y Agid J Xie AL Benabid AM Lozano J Saint-Cyr L Romito MF Contarino M Scerrati V Fraix BN Van (2005) ArticleTitleBilateral deep brain stimulation in Parkinson’s disease: a multicentre study with 4 years follow-up Brain 128 2240–2249 Occurrence Handle15975946 Occurrence Handle1:STN:280:DC%2BD2MrgvFOjtg%3D%3D Occurrence Handle10.1093/brain/awh571

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    R. A. J. Esselink, R. M. A. de Bie & J. D. Speelman

  2. Department of Clinical Epidemiology and Biostatistics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    R. J. de Haan

  3. Department of Neurosurgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    P. R. Schuurman & D. A. Bosch

  4. Department of Neurology and Geriatrics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    R. A. J. Esselink

  5. Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands

    E. N. H. J. Steur

  6. Department of Neurosurgery, Saint Elisabeth Hospital, Tilburg, The Netherlands

    G. N. Beute

  7. Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands

    A. T. Portman

Authors
  1. R. A. J. Esselink
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. M. A. de Bie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. J. de Haan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. N. H. J. Steur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. N. Beute
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. T. Portman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. R. Schuurman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D. A. Bosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. D. Speelman
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Esselink, R., de Bie, R., de Haan, R. et al. Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson’s disease: one year follow-up of a randomised observer-blind multi centre trial. Acta Neurochir (Wien) 148, 1247–1255 (2006). https://doi.org/10.1007/s00701-006-0907-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-006-0907-1

Search

Navigation