Subthalamic stimulation in Parkinson disease: a multidisciplinary approach.
BACKGROUND
High-frequency stimulation of the subthalamic nucleus constitutes a therapeutic advance for severely disabled patients with Parkinson disease.


OBJECTIVE
To evaluate the efficacy and safety of continuous bilateral high-frequency stimulation of the subthalamic nucleus in patients with Parkinson disease.


METHODS
A prospective study of patients with Parkinson disease treated at a university hospital.


METHODS
Electrodes were implanted bilaterally in the subthalamic nucleus of 23 consecutive patients with Parkinson disease who responded well to levodopa but had severe motor complications. There were 16 men and 7 women (mean +/- SEM age, 53 +/- 2 years) who had a mean +/- SEM disease duration of 14.7 +/- 1.0 years. Targets were determined by 3-dimensional magnetic resonance imaging, combined with intraoperative electrophysiologic recordings and stimulation.


RESULTS
Six months after surgery, motor disability, levodopa-induced motor fluctuations, dyskinesias, and the daily dose of levodopa equivalent decreased significantly by 67%, 78%, 77%, and 61%, respectively, compared with the preoperative state. No significant morbidity was observed, except transient depression in 4 patients.


CONCLUSIONS
The beneficial effects of subthalamic stimulation depend on (1) the criteria used for patient selection, (2) the precision with which the subthalamic nucleus is targeted (dependent on the 3-dimensional magnetic resonance imaging and the intraoperative electrophysiologic and clinical assessments), and (3) the long-term postoperative adjustment of stimulation variables.
Houeto
J L
JL
Centre d'Investigation Clinique, Fédération de Neurologie and Institut National de la Santé et de la Recherche Médicale, Unit 289, Paris, France.
Damier
P
P
Bejjani
P B
PB
Staedler
C
C
Bonnet
A M
AM
Arnulf
I
I
Pidoux
B
B
Dormont
D
D
Cornu
P
P
Agid
Y
Y
D000203:Activities of Daily Living; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D018434:Sickness Impact Profile; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome
D007980:Levodopa