Subthalamic nucleus stimulation in Parkinson's disease

Abstract

The aim of the present study was to assess the efficacy and safety of chronic subthalamic nucleus deep-brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). 18 consecutive severely affected PD patients were included (mean age, SD: 56.9+/-6 years; mean disease duration: 13.5+/-4.4 years). All the patients were evaluated clinically before and 6 months after the surgical procedure using the Unified Parkinson's Disease Rating Scale (UPDRS). Additionally, a 12 months follow-up was available in 14 patients. The target coordinates were determined by ventriculography under stereotactic conditions, followed by electrophysiology and intraoperative stimulation. After surgery, continuous monopolar stimulation was applied bilaterally in 17 patients at 2.9+/-0.4 V through 1 (n = 31) or 2 contacts (n = 3). One patient had bilateral bipolar stimulation. The mean frequency of stimulation was 140+/-16 Hz and pulse width 68+/-13 micros. Off medication, the UPDRS part III score (max = 108) was reduced by 55 % during on stimulation (score before surgery: 44.9+/-13.4 vs at 6 months: 20.2+/-10; p < 0.001). In the on medication state, no difference was noted between the preoperative and the postoperative off stimulation conditions (scores were respectively: 17.9+/-9.2 and 23+/-12.6). The severity of motor fluctuations and dyskinesias assessed by UPDRS IV was reduced by 76 % at 6 months (scores were respectively: 10.3+/-3 and 2.5+/-3; p < 0.001). Off medication, the UPDRS II or ADL score was reduced by 52.8 % during on stimulation (26.9+/-6.5 preop versus 12.7+/-7 at 6 months). The daily dose of antiparkinsonian treatment was diminished by 65.5 % (levodopa equivalent dose -- mg/D -- was 1045 +/- 435 before surgery and 360 +/- 377 at 6 months; p < 0.01). These results remained stable at 12 months for the 14 patients studied. Side effects comprised lower limb phlebitis (n = 2), pulmonary embolism (n = 1), depression (n = 6), dysarthria and freezing (n = 1), sialorrhea and drooling (n = 1), postural imbalance (n = 1), transient paresthesias and dyskinesias. This study confirms the great value of subthalamic nucleus stimulation in the treatment of intractable PD. Some adverse events such as depression may be taken into account in the inclusion criteria and also in the post-operative outcome.

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

“…Another noteworthy finding of this study is that the DBS was turned on at lowest level around 1.0 volt from the next day after surgery, which is different from the literature reports 6,11,12,14,16,19,20,28,31,34) . After turning on the minimal stimulation the next day after surgery, the medication was then optimized by attempting to gradually increase the medication to the demand for the best status of motor functions in harmony with the DBS programming.…”

“…Anti-parkinsonian medications were totally withdrawn at six months in nine (24.1%) of 42 patients. The mean LEDD in our study was one of the lowest results of the previous reports 6,11,12,14,16,19,20,28,31,34) . One of the many multi-factorial reasons for the use of about half of the LEDD used in other reports may be a strict dose readjustment following the early reduction of anti-Parkinsonian medications accompanied by the prolonged monitoring in MUMD.…”

Patterns of Bidirectional Communication between Cortex and Basal Ganglia during Movement in Patients with Parkinson Disease

“…The surgical procedure has been detailed in a previous publication (Thobois et al, 2002). Briefly, STN was located by MRI and ventriculography.…”

Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease

“…2,3 Speech deterioration can become a barrier toward fully utilizing the motor benefits of the procedure. 4 In recent reports, using speech item 18 of the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS-III), 5 dysarthria has been reported with a variable prevalence from 1% at 6 months 6 to 56% at 1 year 7,8 and 69.7% at 3 years follow-up, 9 with an average of 9.3%, according to a metaanalysis of 34 articles. 10 Improvement of nonspeech articulatory and phonatory measures has also been reported.…”