Long-term follow up of subthalamic nucleus stimulation in Parkinson’s disease

Romito, Luigi; Scerrati, Massimo; Contarino, Maria Fiorella; Bentivoglio, Anna Rita; Tonali, P.; Albanese, Alberto

doi:10.1212/wnl.58.10.1546

Cited by 135 publications

(132 citation statements)

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“…Among our patients, the duration and disability of LID were reduced by 73% and 77% at 2 years, respectively. The outcomes are comparable to those reported by other investigators (8,17,19,22,23).…”

Section: █ Discussionsupporting

confidence: 89%

“…Stimulation and levodopa may exacerbate contralateral dyskinesia which necessitates a reduction of the daily levodopa dose, which in turn fails to UPDRS score was 33, which was comparable to preoperative motor UPDRS scores reported by other authors (4,26), although other authors utilized unilateral STN DBS in more advanced PD (22,23). Bilateral STN DBS has been reported to provide a 30 to 60% improvement in the total motor UPDRS score (12,17,20,21,28). In a preliminary study reported by Verhagen in 25 patients with a 4-month follow-up unilateral STN DBS reduced the UPDRS motor score by 31% (24).…”

Section: █ Discussionsupporting

confidence: 65%

“…In our series, axial motor features decreased by 18% at 2 years postoperatively in the off state. According to other authors, the improvement of axial motor features ranges between 10 and 36% in the off state (2,4,5,8,17,19,22,23). Axial improvement seen after unilateral STN stimulation can be explained by restoration of excitability to the ipsilateral premotor cortex (7,11).…”

Section: █ Discussionmentioning

confidence: 86%

“…The study by Slowinski et al, based on a battery of neuropsychological tests, revealed an improvement in social functioning, no significant postoperative changes in auditory-verbal attention, generating naming for semantic categories, learning, memory, and mood ratings (22). Other authors have also demonstrated the absence of cognitive deficits after unilateral STN DBS (2,4,5,8,17,19,22,23).…”

Section: █ Discussionmentioning

confidence: 97%

“…Moreover, unilateral STN stimulation procedures are less invasive than bilateral simultaneous STN procedures (2,4,5,8,17,19,22,23). Bearing in mind all of the above facts, we aimed to operate on PD patients with the asymmetry of PD symptoms.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Unilateral subthalamic nucleus stimulation in the treatment of asymmetric parkinson's disease with early motor complications.

Sobstyl¹,

Ząbek²,

Zaczyński³

et al. 2015

Turkish Neurosurgery

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Patients with advanced PD and older age at surgery may not easily tolerate bilateral STN DBS, unlike younger patients with moderate PD. Moreover, approximately 30% of patients with long-standing PD develop depression, which is partially attributable to the disease itself. Dementia in PD patients is related to the age of PD onset, rather than to the duration of the disease (6,9,14,16). Psychiatric symptoms -such as compulsive behavior, gambling etc. -may be triggered or aggravated by long-term medication, especially in dopamine agonist therapy (14,27). Moreover, in the course of the disease a number of █ InTRODuCTIOn P arkinson's disease (PD) is diagnosed clinically based on the cardinal motor symptoms including resting tremor, rigidity and bradykinesia. A characteristic feature of early idiopathic PD is asymmetric motor symptom onset. In advanced PD, it is sometimes difficult to recognize which side of the body was first affected by disease. Generally, patients with advanced PD, with severe bilateral levodopa-induced dyskinesia (LID) and motor fluctuations require bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) (17,21). AIM:The aim of this study was to assess the results of unilateral subthalamic nucleus (STN) stimulation for the treatment of Parkinson's disease (PD) with marked asymmetry of parkinsonian motor symptoms and early motor complications. MATERIAL and METhODS:The clinical series consisted of 32 consecutive PD patients, in whom unilateral STN stimulation was performed. All patients were assessed according to the Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn and Yahr staging. The patients were assessed preoperatively, and at 12, and 24 months after unilateral STN stimulation. 22 patients were followed for 2 years. RESuLTS:Medication off/stimulation on total UPDRS motor scores were improved by 29% when compared to the baseline medication off motor scores. The contralateral motor scores improved by 49%, whereas the axial motor scores by 18% in medication off/stimulation on condition. The duration and severity of levodopa induced dyskinesia were reduced respectively by 73% and by 77%. The daily levodopa dose was decreased by only 10%.COnCLuSIOn: Unilateral STN stimulation is a safe and effective procedure for selected patients with marked asymmetry Parkinson's disease motor symptoms and early motor complications.

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