Deep brain stimulation for the treatment of Parkinson's disease: subthalamic nucleus versus globus pallidus internus.
OBJECTIVE
Deep brain stimulation of the basal ganglia has become a promising treatment option for patients with Parkinson's disease who have side effects from drugs. Which is the best target-globus pallidus internus (GPi) or subthalamic nucleus (STN)-is still a matter of discussion. The aim of this prospective study is to compare the long term effects of GPi and STN stimulation in patients with severe Parkinson's disease.


METHODS
Bilateral deep brain stimulators were implanted in the GPi in six patients and in the STN in 12 patients with severe Parkinson's disease. Presurgery and 3, 6, and 12 months postsurgery patients were scored according to the CAPIT protocol.


RESULTS
Stimulation of the STN increased best Schwab and England scale score significantly from 62 before surgery to 81 at 12 months after surgery; GPi stimulation did not have an effect on the Schwab and England scale. Stimulation of the GPi reduced dyskinesias directly whereas STN stimulation seemed to reduce dyskinesias by a reduction of medication. Whereas STN stimulation increased the unified Parkinson's disease rating scale (UPDRS) motor score, GPi stimulation did not have a significant effect. Fluctuations were reduced only by STN stimulation and STN stimulation suppressed tremor very effectively.


CONCLUSIONS
Stimulation of the GPi reduces medication side effects, which leads to a better drug tolerance. There was no direct improvement of bradykinesia or tremor by GPi stimulation. Stimulation of the STN ameliorated all parkinsonian symptoms. Daily drug intake was reduced by STN stimulation. The STN is the target of choice for treating patients with severe Parkinson's disease who have side effects from drugs.
Department of Neurology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany. martin_krause@med.uni-heidelberg.de
M
M
Krause
W
W
Fogel
A
A
Heck
W
W
Hacke
M
M
Bonsanto
C
C
Trenkwalder
V
V
Tronnier
D000368:Aged; D004558:Electric Stimulation / Q000009:adverse effects*; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D013997:Time Factors