Journal Mobile Options
Table of Contents
Vol. 58, No. 4, 2007
Issue release date: November 2007
Eur Neurol 2007;58:218–223
(DOI:10.1159/000107943)

Motor and Nonmotor Symptom Follow-Up in Parkinsonian Patients after Deep Brain Stimulation of the Subthalamic Nucleus

Zibetti M. · Torre E. · Cinquepalmi A. · Rosso M. · Ducati A. · Bergamasco B. · Lanotte M. · Lopiano L.
aDepartment of Neuroscience, University of Turin, Turin, and bS. Maugeri Foundation, Pavia, Italy

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Objective: To evaluate motor and nonmotor symptoms in patients with Parkinson’s disease undergoing bilateral deep brain stimulation of the subthalamic nucleus (STN DBS). Methods: Thirty-six consecutive patients receiving bilateral STN stimulation implants were evaluated preoperatively as well as 12 and 24 months after surgery. Motor symptoms were assessed through the Unified Parkinson’s Disease Rating Scale (UPDRS). Data concerning nonmotor symptoms were collected from items of the UPDRS and 2 additional questions from clinical charts regarding constipation and urological dysfunction. Results: STN DBS was effective in controlling motor symptoms; concerning nonmotor symptoms, sleep quality and constipation improved after surgery as compared to baseline. Salivation, swallowing and sensory complaints were ameliorated to a comparable degree by the medication on state, whether preoperatively or postoperatively. With a lower dose of dopaminergic medication, however, the medication on state appeared to be a much larger percentage of the day postoperatively. No significant variations were detected in intellectual impairment, depression, thought disorders, motivation, falling unrelated to freezing, nausea, orthostatic hypotension and urological dysfunction. Conclusions: STN DBS effectively controls motor symptoms, while nonmotor features of advanced Parkinson’s disease patients are mostly unchanged after surgery, even though some specific aspects, notably sleep complaints and constipation, are ameliorated.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Shulman LM, Taback RL, Bean J, et al: Comorbidity of the nonmotor symptoms of Parkinson’s disease. Mov Disord 2001;16:507–510.
  2. Weintraub D, Moberg PJ, Duda JE, et al: Effect of psychiatric and other nonmotor symptoms on disability in Parkinson’s disease. Am Geriatr Soc 2004;52:784–788.
  3. Slawek J, Derejko M, Lass P: Factors affecting the quality of life of patients with idiopathic Parkinson’s disease – a cross-sectional study in outpatient clinic attendees. Parkinsonism Relat Disord 2005;11:465–468.
  4. Adler CH: Nonmotor complications in Parkinson’s disease. Mov Disord 2005;20(suppl 11):23–29.

    External Resources

  5. Lieberman A: Depression in Parkinson’s disease – a review. Acta Neurol Scand 2006;113:1–8.
  6. Aarsland D, Larsen JP, Lim NG, et al: Range of neuropsychiatric disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999;64:492–496.
  7. Marder K, Tang M-X, Cote L, et al: The frequency and associated risk factors for dementia in patients with Parkinson’s disease. Arch Neurol 1995;52:695–701.
  8. Micieli G, Tosi P, Marcheselli S, et al: Autonomic dysfunction in Parkinson’s disease. Neurol Sci 2003;24(suppl 1):32–34.

    External Resources

  9. Araki I, Kitahara M, Oida T, Kuno S: Voiding dysfunction and Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol 2000;164:1640–1643.
  10. Sakakibara R, Odaka T, Uchiyama T, et al: Colonic transit time and rectoanal videomanometry in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2003;74:268–272.
  11. Leopold NA, Kagel MC: Prepharingeal dysphagia in Parkinsons’s disease. Dysphagia 1996;11:14–22.
  12. Fuh JL, Lee RC, Wang SJ, et al: Swallowing difficulty in Parkinson’s disease. Clin Neurol Neurosurg 1997;99:106–112.
  13. Edwards LL, Pfeiffer RF, Quigley EM, et al: Gastrointestinal symptoms in Parkinson’s disease. Mov Disord 1991;6:151–156.
  14. Kumar S, Bhatia M, Behari M: Sleep disorders in Parkinson’s disease. Mov Disord 2002;17:775–781.
  15. Goetz CG, Tanner CM, Levy M, et al: Pain in Parkinson’s disease. Mov Disord 1986;1:45–49.
  16. Ford B: Pain in Parkinson’s disease. Clin Neurosci 1998;5:63–72.
  17. Quinn NP, Lang AE, Koller WC, et al: Painful Parkinson’s disease. Lancet 1986;1:1366–1369.
  18. Krack P, Batir A, Van Blercom N, et al: Five years follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003;349:1925–1934.
  19. Rodriguez-Oroz MC, Obeso JA, Lang AE, et al: Bilateral deep brain stimulation in Parkinson’s disease: a multicentre study with 4 years follow-up. Brain 2005;128:2240–2249.
  20. Takeshita S, Kurisu K, Trop L, et al: Effect of subthalamic stimulation on mood state in Parkinson’s disease: evaluation of previous facts and problems. Neurosurg Rev 2005;28:179–186.
  21. Herzog J, Volkmann J, Krack P, et al: Two-year follow-up of subthalamic deep brain stimulation in Parkinson’s disease. Mov Disord 2003;18:1332–1337.
  22. Arnulf I, Bejjani BP, Garma L, et al: Improvement of sleep architecture in PD with subthalamic nucleus stimulation. Neurology 2000;55:1732–1734.
  23. Iranzo A, Valldeoriola F, Santamaria J, et al: Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002;72:661–664.
  24. Cicolin A, Lopiano L, Zibetti M, et al: Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med 2004;5:207–210.
  25. Seif C, Herzog J, van der Horst C, et al: Effect of subthalamic deep brain stimulation on the function of the urinary bladder. Ann Neurol 2004;55:118–120.
  26. Finazzi-Agro E, Peppe A, D’Amico A, et al: Effects of subthalamic nucleus stimulation on urodynamic findings in patients with Parkinson’s disease. J Urol 2003;169:1388–1391.
  27. Holmberg B, Corneliusson O, Elam M: Bilateral stimulation of nucleus subthalamicus in advanced Parkinson’s disease: no effects on, and of, autonomic dysfunction. Mov Disord 2005;20:976–981.
  28. Hughes AJ, Daniel SE, Kilford L, Lees AJ: Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181–184.
  29. Lang AE, Widner H: Deep brain stimulation for Parkinson’s disease: patient selection and evaluation. Mov Disord 2002;17(suppl 3):94–101.

    External Resources

  30. Lanotte M, Rizzone M, Bergamasco B, et al: Deep brain stimulation of the subthalamic nucleus: anatomical, neurophysiological, and outcome correlations with the effects of stimulation. J Neurol Neurosurg Psychiatry 2002;72:53–58.
  31. Defer GL, Widner H, Marie RM, et al: Core assessment program for surgical interventional therapies in Parkinson’s disease (CAPSIT-PD). Mov Disord 1999;14:572–584.
  32. Grosset K, Needleman F, Macphee G, et al: Switching from ergot to nonergot dopamine agonists in Parkinson’s disease: a clinical series and five-drug dose conversion table. Mov Disord 2004;19:1370–1374.
  33. Ashraf W, Wszolek ZK, Pfeiffer RF, et al: Anorectal function in fluctuating (on-off) Parkinson’s disease: evaluation by combined anorectal manometry and electromyography. Mov Disord 1995;10:650–657.
  34. Brefel-Courbon C, Payoux P, Thalamas C, et al: Effect of levodopa on pain threshold in Parkinson’s disease: a clinical and positron emission tomography study. Mov Disord 2005;20:1557–1563.
  35. Temel Y, Blokland A, Steinbuch WM, et al: The functional role of the subthalamic nucleus in cognitive and limbic circuits. Prog Neurobiol 2005;76:393–413.
  36. Temel Y, Visser-Vandewalle V: Behavioural effects of subthalamic stimulation in advanced Parkinson disease: a systematic review. Proc World Soc Stereotact Funct Neurosurg, 2005, pp 11–18.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50