Bilateral high‐frequency stimulation of the internal globus pallidus in advanced Parkinson's disease

Abstract

We report here the results of an open prospective study in 9 patients suffering from severe Parkinson's disease with on/off fluctuations and restricted off-period mobility, who underwent bilateral implantation of stimulating electrodes in the internal pallidum. At 3-month follow-up, the total Unified Parkinson's Disease Rating Scale (UPDRS) motor score in the medication-off state was reduced from 54.1+/-14.8 to 23.9+/-11.7 (44.2%) when stimulation was turned on. Comparison of UPDRS subscores revealed significant improvements for tremor, rigidity, bradykinesia, gait and posture, and dyskinesias. The results of the clinical scoring could be confirmed by significant changes in the quantitative assessment of hand function and walking. Bilateral pallidal stimulation reduced the amount and severity of on/off fluctuations. Additional follow-up at 6 months (n=6), 9 months (n=6), and 12 months (n=4) did not show a decline in effectiveness of stimulation. There was no permanent morbidity associated with the procedure. A subtle reduction of verbal fluency, which was not evident to the patients, was the only cognitive side effect of the procedure in neuropsychological testing. Chronic bilateral high-frequency stimulation of the internal pallidum seems to be a neurologically safe and highly effective treatment for "off" symptoms, dyskinesias, and motor fluctuations in advanced stages of Parkinson's disease.

Evaluation of healthcare utilization and health status of patients with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus

“…Each patient underwent a complete medical and neurological examination including a uniform, structured assessment of parkinsonian signs and symptoms (UPDRS) [17]. Selection and exclusion criteria of PD patients have been described previously [24,33,34]. Drug therapy for PD followed the guidelines proposed by Quinn and Oertel [29].…”

“…All patients were under a stable drug therapy before considering DBS-STN. The neurosurgical procedure used by the two centers has been previously described in detail [24,33,34]. One patient (Düsseldorf) was initially hospitalized for a final attempt of a high-dose dopamine agonist treatment and underwent surgery during the same stay after this treatment attempt had failed and his original medication had to be restituted.…”

Effects of pallidal deep brain stimulation and levodopa treatment on reaction-time performance in Parkinson’s disease

“…The details of the stereotactic procedure for placement of the GPi electrodes have been described elsewhere (Volkmann et al 1998).…”

“…In the medication-on state, patients took an equivalent of their regular dopaminergic morning dose as shortacting levodopa formulation. Dopamine agonists were converted to LEDDs given the conversion formula provided by Volkmann et al (1998). Before starting the test, we waited for the patient and the examiner to agree upon the best medication-on condition.…”

Thalamic, subthalamic nucleus and internal pallidum stimulation in Parkinson’s disease

“…There is no comparative study available between the two procedures. GPi stimulation greatly decreases levodopa induced dyskinesias in most studies [4,14,20,29,[31][32][33]. The effect on off-symptoms varies between studies from none to important [4,14,20,29,[31][32][33].…”