Subthalamic nucleus deep brain stimulation for parkinson's disease after successful pallidotomy: clinical and electrophysiological observations.
Unilateral pallidotomy is an effective treatment for contralateral parkinsonism and dyskinesia, yet symptoms progress in many patients. Little is known about whether such patients obtain a useful response to subsequent bilateral subthalamic nucleus deep brain stimulation (STN DBS). Changes in Unified Parkinson's Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores, medication requirements, and dyskinesias were measured. Clinical outcomes were compared to patients with de novo STN DBS. Neuronal recordings were performed. STN DBS resulted in a significant reduction in UPDRS Motor scores (42.1%; 95% confidence interval [CI], 26.9-57.4; P = 0.03), comparable with de novo STN DBS surgery (41%; 95% CI, 26-46%; P < 0.001). There was also less change in dyskinesia duration and disability scores (P = 0.017, 0.005). There were no side-to-side differences clinically or in the STN neuronal firing rates and patterns. Bilateral STN DBS is safe and efficacious in improving motor symptoms in patients with prior pallidotomy.
Kleiner-Fisman
Galit
G
Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Fisman
David N
DN
Zamir
Orit
O
Dostrovsky
Jonathan O
JO
Sime
Elspeth
E
Saint-Cyr
Jean A
JA
Lozano
Andres M
AM
Lang
Anthony E
AE
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D010300:Parkinson Disease / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology*