Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson's disease.
BACKGROUND
High frequency stimulation of the subthalamic nucleus (STN) is an alternative but expensive neurosurgical treatment for parkinsonian patients with levodopa induced motor complications.


OBJECTIVE
To assess the safety, clinical effects, quality of life, and economic cost of STN stimulation.


METHODS
We conducted a prospective multicentre study in 95 consecutive Parkinson's disease (PD) patients receiving bilateral STN stimulation and assessed its effects over 12 months. A double blind randomised motor evaluation was carried out at 3 month follow up, and quality of life, self care ability, and predictive factors of outcome following surgery were assessed. The cost of PD was estimated over 6 months before and after surgery.


RESULTS
The Unified Parkinson's Disease Rating Scale (UPDRS) motor score improved by 57% (p<0.0001) and activities of daily living improved by 48% (p<0.0001) at 12 month follow up. Double blind motor scoring improved by 51% at 3 month follow up (p<0.0001). The total PD Quality of Life Questionnaire (PDQL-37) score improved by 28% (p<0.001). The better the preoperative motor score after a levodopa challenge, the better the outcome after STN stimulation. Five patients developed an intracerebral haematoma during electrode implantation with permanent after effects in two. The 6 month costs of PD decreased from 10,087 euros before surgery to 1673 euros after surgery (p<0.0001) mainly because of the decrease in medication. These savings allowed a return on the procedure investment, estimated at 36,904 euros over 2.2 years.


CONCLUSIONS
STN stimulation has good outcomes with relatively low risk and little cost burden in PD patients with levodopa induced motor complications.
Department of Neurology and Neurosurgery, Grenoble University Hospital and INSERM U318 Joseph Fourier University, Grenoble Cedex 9, France.
V
V
Fraix
J-L
JL
Houeto
C
C
Lagrange
C
C
Le Pen
P
P
Krystkowiak
D
D
Guehl
C
C
Ardouin
M-L
ML
Welter
F
F
Maurel
L
L
Defebvre
A
A
Rougier
A-L
AL
Benabid
V
V
Mesnage
M
M
Ligier
S
S
Blond
P
P
Burbaud
B
B
Bioulac
A
A
Destée
P
P
Cornu
P
P
Pollak
D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000191:economics* / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007980:Levodopa / Q000191:economics / Q000627:therapeutic use; D008297:Male; D010300:Parkinson Disease / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D020531:Subthalamic Nucleus / Q000502:physiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa