title: Parkinson's disease, subthalamic stimulation, and selection of candidates: a pathological study.
abstract: We report on a patient with Parkinson's disease (PD) who was moderately improved by stimulation of the subthalamic nucleus (STN) and died 2 years after electrode implantation. After neurosurgery, symptoms that had responded to levodopa treatment preoperatively continued to improve. Postural instability, dysarthria, and cognitive impairment continued to worsen, despite STN stimulation and levodopa treatment. Postmortem examination of the brain confirmed the diagnosis of PD and showed that the electrodes had been correctly positioned within the STN. The failure of STN stimulation in this patient confirms the importance of screening and excluding patients from surgery with evolving parkinsonian axial symptoms or cognitive impairment.
authors.affiliation: Fédération de Neurologie, Centre d'Investigation Clinique and Institut National de la Santé et de la Recherche Médicale (INSERM) U289, Hôpital de la Salpêtrière, Paris, France.
authors.forename: Bechir
authors.initials: B
authors.lastname: Jarraya
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bonnet
authors.forename: Charles
authors.initials: C
authors.lastname: Duyckaerts
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Houeto
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Hauw
authors.forename: Yves
authors.initials: Y
authors.lastname: Agid
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects; D003072:Cognition Disorders / Q000175:diagnosis; D018450:Disease Progression; D004409:Dyskinesia, Drug-Induced / Q000209:etiology; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000502:physiology*; D014202:Tremor / Q000503:physiopathology
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa