Electrical Stimulation of the Subthalamic Nucleus in Advanced Parkinson's Disease

Abstract

Electrical stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease. The severity of symptoms off medication decreases, and the dose of levodopa can be reduced with consequent reduction in dyskinesias.

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

“…The improvement of both the motor score (UPDRS III) and the activities of daily living score (UPDRS II), was paralleled by an increase of the Schwab and England score up to 50 % six months after the surgical procedure which reflected the higher level of independence. These data are in accordance with recently published results from clinical studies [7,22,24,27].…”

“…Previous studies have shown that the mean dosage of levodopa as well as the mean dosage of dopamine agonists could be reduced following DBS-STN [22,27]. Furthermore, one study reported that in nine out of ten patients the expensive treatment with apomorphine could be discontinued 12 months following continuous high-frequency stimulation [24]. Similar results were observed in our group of patients.…”

“…Extrapolating these data, annual savings of DM 8,610 (US$ 4,480, EUR€ 4,390, GB£ 2,760) can be achieved following DBS-STN in our group of PD patients. The annual savings would be even higher if the subcutaneous administration of apomorphine could be discontinued thanks to the effects of DBS-STN [12,24,26]. No patients using s. c. apomorphine were included in this study.…”

“…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.…”