Unilateral stimulation of the subthalamic nucleus in Parkinson disease: a double-blind 12-month evaluation study.
OBJECTIVE
Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been established as an effective treatment for Parkinson disease (PD). Nevertheless, bilateral surgical procedures can be associated with frequent and severe complications. The aim in the present study was to assess the safety and efficacy of unilateral STN stimulation, and the need for a second procedure.


METHODS
Twelve patients with PD underwent unilateral DBS of the STN and were followed up for 12 months. Patients were assessed at baseline and at each visit in a double-blind fashion by analyzing the Unified PD Rating Scale (UPDRS), ambulation speed, and home diaries. Levodopa-off/stimulation-on UPDRS motor scores were improved by 26 +/- 8% (p < 0.05, mean +/- standard deviation [SD]) compared with the baseline levodopa-off score; there was a 50% improvement in contralateral features, a 17% improvement ipsilaterally, and a 36% improvement in axial features. The mean ambulation speed increased by 83 +/- 44% (p < 0.01, mean +/- SD). The medication-on time with dyskinesias was significantly reduced (p < 0.01) and the daily levodopa dose was reduced by 19 +/- 6% (p < 0.05, mean +/- SD). There were no clinically significant side effects.


CONCLUSIONS
Unilateral DBS of the STN is safe and well tolerated, and may provide sufficient benefit so that additional surgery is not required.
Germano
Isabelle M
IM
Department of Neurosurgery, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA. isabelle.germano@msnyuhealth.org
Gracies
Jean-Michel
JM
Weisz
Donald J
DJ
Tse
Winona
W
Koller
William C
WC
Olanow
C Warren
CW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000008:administration & dosage; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010300:Parkinson Disease / Q000628:therapy*; D020531:Subthalamic Nucleus; D013997:Time Factors
D000978:Antiparkinson Agents; D007980:Levodopa