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Vol. 84, No. 5-6, 2006
Issue release date: November 2006

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

Liang G.S. · Chou K.L. · Baltuch G.H. · Jaggi J.L. · Loveland-Jones C. · Leng L. · Maccarone H. · Hurtig H.I. · Colcher A. · Stern M.B. · Kleiner-Fisman G. · Simuni T. · Siderowf A.D.
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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.



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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.
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References

  1. Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid AL: Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 1998;339:1105–1111.
  2. Simuni T, Jaggi JL, Mulholland H, Hurtig HI, Colcher A, Siderowf AD, Ravina B, Skolnick BE, Goldstein R, Stern MB, Baltuch GH: Bilateral stimulation of the subthalamic nucleus in patients with Parkinson disease: a study of efficacy and safety. J Neurosurg 2002;96:666–672.
  3. Deep-Brain Stimulation for Parkinson’s Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001;345:956–963.
  4. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P: Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003;349:1925–1934.
  5. Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P, Rehncrona S, Kulisevsky J, Albanese A, Volkmann J, Hariz MI, Quinn NP, Speelman JD, Guridi J, Zamarbide I, Gironell A, Molet J, et al: Bilateral deep brain stimulation in Parkinson’s disease: a multicentre study with 4 years follow-up. Brain 2005;128:2240–2249.
  6. Vingerhoets FJ, Villemure JG, Temperli P, Pollo C, Pralong E, Ghika J: Subthalamic DBS replaces levodopa in Parkinson’s disease: two-year follow-up. Neurology 2002;58:396–401.
  7. Krause M, Fogel W, Mayer P, Kloss M, Tronnier V: Chronic inhibition of the subthalamic nucleus in Parkinson’s disease. J Neurol Sci 2004;219:119–124.
  8. Jaggi JL, Umemura A, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH: Bilateral stimulation of the subthalamic nucleus in Parkinson’s disease: surgical efficacy and prediction of outcome. Stereotact Funct Neurosurg 2004;82:104–114.
  9. Fahn S, Elton RL: Unified Parkinson’s Disease Rating Scale; in Fahn S, Marsden CD, Calne D, Goldstein M (eds): Recent Developments in Parkinson’s Disease. Florham Park, Macmillan Health Care Information, 1987, pp 153–163.
  10. Hoehn MM, Yahr MD: Parkinsonism: onset, progression and mortality. Neurology 1967;17:427–442.
  11. Schwab R, England A: Projection technique for evaluating surgery in Parkinson’s disease; in Gillingham FJ, Donaldson IML (eds): Third Symposium on Parkinson’s Disease. Edinburgh, Livingstone, 1969, pp 152–158.
  12. Herzog J, Volkmann J, Krack P, Kopper F, Potter M, Lorenz D, Steinbach M, Klebe S, Hamel W, Schrader B, Weinert D, Muller D, Mehdorn HM, Deuschl G: Two-year follow-up of subthalamic deep brain stimulation in Parkinson’s disease. Mov Disord 2003;18:1332–1337.
  13. Kleiner-Fisman G, Fisman DN, Sime E, Saint-Cyr JA, Lozano AM, Lang AE: Long-term follow-up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg 2003;99:489–495.
  14. Wenzelburger R, Zhang BR, Poepping M, Schrader B, Muller D, Kopper F, Fietzek U, Mehdorn HM, Deuschl G, Krack P: Dyskinesias and grip control in Parkinson’s disease are normalized by chronic stimulation of the subthalamic nucleus. Ann Neurol 2002;52:240–243.
  15. Temperli P, Ghika J, Villemure JG, Burkhard PR, Bogousslavsky J, Vingerhoets FJ: How do parkinsonian signs return after discontinuation of subthalamic DBS? Neurology 2003;60:78–81.
  16. Rodriguez-Oroz MC, Zamarbide I, Guridi J, Palmero MR, Obeso JA: Efficacy of deep brain stimulation of the subthalamic nucleus in Parkinson’s disease 4 years after surgery: double blind and open label evaluation. J Neurol Neurosurg Psychiatry 2004;75:1382–1385.
  17. Richards M, Marder K, Cote L, Mayeux R: Interrater reliability of the Unified Parkinson’s Disease Rating Scale motor examination. Mov Disord 1994;9:89–91.
  18. Welter ML, Houeto JL, Tezenas du Montcel S, Mesnage V, Bonnet AM, Pillon B, Arnulf I, Pidoux B, Dormont D, Cornu P, Agid Y: Clinical predictive factors of subthalamic stimulation in Parkinson’s disease. Brain 2002;125:575–583.


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