Parkinson's disease, subthalamic stimulation, and selection of candidates: a pathological study.
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.
Jarraya
Bechir
B
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.
Bonnet
Anne-Marie
AM
Duyckaerts
Charles
C
Houeto
Jean-Luc
JL
Cornu
Philippe
P
Hauw
Jean-Jacques
JJ
Agid
Yves
Y
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
D000978:Antiparkinson Agents; D007980:Levodopa