Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year follow up

Abstract

Objective: To measure the effect of deep brain stimulation (DBS) of the subthalamic nucleus in patients with advanced Parkinson's disease. Design: Open label follow up using blinded ratings of videotaped neurological examinations. Patients: 30 patients with advanced Parkinson's disease (19 male, 11 female; mean age 58.8 years; mean disease duration 12.8 years), complicated by intractable wearing off motor fluctuations and dopaminergic dyskinesias. Main outcome measures: Unified Parkinson's disease rating scale (UPDRS), part III (motor), score at one year, from blinded reviews of videotaped neurological examinations. Secondary outcomes included the other UPDRS subscales, Hoehn and Yahr scale, activities of daily living (ADL) scale, mini-mental state examination (MMSE), estimates of motor fluctuations and dyskinesia severity, drug intake, and patient satisfaction questionnaire. Results: Subthalamic nucleus stimulation was associated with a 29.5% reduction in motor scores at one year (p,0.0001). The only important predictors of improvement in UPDRS part III motor scores were the baseline response to dopaminergic drugs (p = 0.015) and the presence of tremor (p = 0.027). Hoehn and Yahr scores and ADL scores in the ''on'' and ''off'' states did not change, nor did the mean MMSE score. Weight gain occurred in the year after surgery, from (mean) 75.8 kg to 78.5 kg (p = 0.028). Duration of daily wearing off episodes was reduced by 69%. Dyskinesia severity was reduced by 60%. Drug requirements (in levodopa equivalents) declined by 30%. Conclusions: The 30% improvement in UPDRS motor scores was a more modest result than previously reported. DBS did not improve functional capacity independent of drug use. Its chief benefits were reduction in wearing off duration and dyskinesia severity.

Stimulation of the subthalamic nucleus in Parkinson's disease: a 5 year follow up

“…In conclusion, our findings confirm the results of the previous long term study of 49 consecutive patients treated with bilateral stimulation of the STN. 9 The results differ, however, from some studies performed after shorter evolution times in which far less improvement of parkinsonian motor disability was found after STN stimulation, [6][7][8] although they are consistent with others. [3][4][5] Differences in the clinical evaluations, neurosurgical procedures, and methods of assessment may explain inconsistencies between studies.…”

“…[3][4][5] Other groups, however, have obtained less satisfactory results. [6][7][8] Little is known about the long term outcome of STN stimulation. There is only one report of a 5 year follow up of a cohort of 49 patients with advanced PD who underwent surgery.…”

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease

“…For instance, a functional imaging study demonstrated a continuous decline of dopaminergic function in patients with advanced PD after bilateral STN stimulation. 8,15,24,40 One study included in our meta-analysis stated that medication doses were higher after GPi DBS compared with preoperative doses. 53 Our review confirms that STN DBS was more likely to reduce than to increase levels of medications for patients with PD.…”

Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

“…The calculated incidence of complications associated with laparoscopic bariatric surgery, obtained from the case series, 4,8,10,17,28,38,44,45,52,74,77,82,83,91,120 is summarized in Table 1; complications associated with DBS studies are shown in Table 2. 6,7,9,12,16,20,26,27,31,37,39,47,[55][56][57][58][59][60][61]64,[67][68][69]71,78,80,81,84,[86][87][88][89][96][97]…”