Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year follow up.
OBJECTIVE
To measure the effect of deep brain stimulation (DBS) of the subthalamic nucleus in patients with advanced Parkinson's disease.


METHODS
Open label follow up using blinded ratings of videotaped neurological examinations.


METHODS
30 patients with advanced Parkinson's disease (19 male, 11 female; mean age 58.8 years; mean disease duration 12.8 years), complicated by intractable wearing off motor fluctuations and dopaminergic dyskinesias.


METHODS
Unified Parkinson's disease rating scale (UPDRS), part III (motor), score at one year, from blinded reviews of videotaped neurological examinations. Secondary outcomes included the other UPDRS subscales, Hoehn and Yahr scale, activities of daily living (ADL) scale, mini-mental state examination (MMSE), estimates of motor fluctuations and dyskinesia severity, drug intake, and patient satisfaction questionnaire.


RESULTS
Subthalamic nucleus stimulation was associated with a 29.5% reduction in motor scores at one year (p<0.0001). The only important predictors of improvement in UPDRS part III motor scores were the baseline response to dopaminergic drugs (p = 0.015) and the presence of tremor (p = 0.027). Hoehn and Yahr scores and ADL scores in the "on" and "off" states did not change, nor did the mean MMSE score. Weight gain occurred in the year after surgery, from (mean) 75.8 kg to 78.5 kg (p = 0.028). Duration of daily wearing off episodes was reduced by 69%. Dyskinesia severity was reduced by 60%. Drug requirements (in levodopa equivalents) declined by 30%.


CONCLUSIONS
The 30% improvement in UPDRS motor scores was a more modest result than previously reported. DBS did not improve functional capacity independent of drug use. Its chief benefits were reduction in wearing off duration and dyskinesia severity.
Center for Movement Disorders Surgery, Columbia-Presbyterian Medical Center, Columbia University, New York, NY 10032, USA. bford@neuro.columbia.edu
B
B
Ford
L
L
Winfield
S L
SL
Pullman
S J
SJ
Frucht
Y
Y
Du
P
P
Greene
J H
JH
Cheringal
Q
Q
Yu
L J
LJ
Cote
S
S
Fahn
G M
GM
McKhann
R R
RR
Goodman
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D020820:Dyskinesias / Q000209:etiology / Q000628:therapy; D004599:Electric Stimulation Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000209:etiology* / Q000628:therapy*; D015588:Observer Variation; D010300:Parkinson Disease / Q000628:therapy*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome; D014741:Video Recording
D000978:Antiparkinson Agents