Long-Term Outcomes of Bilateral Subthalamic Nucleus Stimulation in Patients with Advanced Parkinson’s Disease

Abstract

Background: In patients with advanced Parkinson’s disease (PD), deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been shown to improve motor function and decrease medication requirements in the short term. However, the long-term benefits of DBS are not yet established. Objective: It was the aim of this study to evaluate long-term outcomes of patients with PD treated with bilateral DBS of the STN. Design and Methods: Thirty-three subjects who had bilateral STN DBS were followed prospectively after surgery. We evaluated subjects, using the Unified Parkinson’s Disease Rating Scale (UPDRS), preoperatively, 12 months after surgery and at a long-term follow-up visit. Ratings were performed on and off dopaminergic medications. We compared postoperative UPDRS scores, dyskinesia ratings and medication dosages with preoperative values. Results: Twenty-seven subjects had evaluations beyond 18 months (median 33.7 months). Total UPDRS scores in the ‘medication-off’ state were improved by 37% (p < 0.001) at 12 months and 17.7% (p = 0.0051) at the long-term evaluation. Medication-off state UPDRS part III scores were significantly improved at both 1 year and at the last evaluation (37.6 and 29.3%; p < 0.001). Dopaminergic medication requirements were decreased by 35.3% (p < 0.001) during the first postoperative year and remained below preoperative levels at the long-term evaluation. Average duration of ‘off’ time remained decreased by about 40% at both 1 year and at the time of last evaluation. Subjects had a sustained reduction in dyskinesia severity (88.6% at 1 year and 68.8% at last evaluation). Conclusions: In this cohort of subjects with advanced PD, bilateral STN stimulation improved ‘off’ medication motor function, reduced time spent in the medication-off state and reduced medication requirements for up to 4 years after surgery. We conclude that STN DBS is an effective long-term therapy for selected patients with advanced PD.

Deep brain stimulation - effects on swallowing function in Parkinson's disease

“…Stimulation seemed to improve some aspects of pharyngeal swallowing while the oral stage was unaffected (22). In other reports, the effects of DBS surgery on swallowing functionality varies from unchanged (23,24), to a clear-cut deterioration (25). Dysphagia has further been reported as a rare complication after STN DBS, which in some of the cases was clearly related to the stimulation (26)(27)(28)(29).…”

Advances in Therapeutic Options for Gait and Balance in Parkinson’s Disease

“…[112][113][114][115][116] An equally common finding in these long term studies, however, is worsening gait function. One recent study, for example, reported 10-year outcomes of bilateral STN DBS in PD.…”

Estimation of Electrode Position with Fused Images of Preoperative MRI and Postoperative CT Using the Mutual Information Technique After STN DBS in Patients with Advanced Parkinson's Disease

“…Many studies have shown stable improvement in patients' UDPRS scores after bilateral STN DBS (Krack et al, 2003;Liang et al, 2006;Ostergaard & Sunde., 2006;Piboolnurak et al, 2007;Wider et al, 2008;Tsai et al, 2009), although the scores were observed to diminish over time due to disease progression (Olanow et al, 1995;Louis et al, 1999;Jankovic et al, 2001;Krack et al, www.intechopen.com Rodriguez-Oroz et al, 2005;Tsai et al, 2009). In a review of the literature, Benabid et al (2009) found that improvements in UDPRS III scores after STN DBS were reasonably stable over time, decreasing from 66% improvement at one year to 54% improvement five years after surgery (Benabid et al, 2009).…”