title: Effects of chronic subthalamic stimulation on nonmotor fluctuations in Parkinson's disease.
abstract: The aim of this study was to assess the outcome of nonmotor fluctuations (NMF) after chronic Subthalamic nucleus (STN) Deep Brain Stimulation (DBS) in Parkinson's disease(PD). Chronic stimulation of the STN has proved to be an effective treatment for advanced PD with motor complications. The outcome of NMF, which are also disabling, remains unknown. Forty-patients underwent bilateral STN stimulation. Each patient was interviewed before and after 1 yr of STN DBS with a structured questionnaire about their NMF. After 1 yr of chronic stimulation, the improvement in the motor score (UPDRS III) and dyskinesia amounted respectively to 67.4 and 76.3%. The decrease in motor fluctuations (MF) was 59% and 13 patients reported that their MF had disappeared. Comparatively, a reduction of the total number of NMF was also observed (mean number preoperatively: 15.6 per patient, postoperatively: 6.6). Most of the nonmotor fluctuating symptoms occurred in the "off" state preoperatively and no longer depended on the patient's motor state after surgery. The improvement in NMF was not identical for the different categories: pain/sensory fluctuations showed the best response to STN DBS (84.2%). Dysautonomic and cognitive fluctuations were also markedly improved (>60%) while psychic fluctuations remained the most frequent postoperative NMF observed. Some incapacitating manifestations such as drenching sweats and akathisia showed a remarkably good response to STN stimulation. In conclusion STN DBS alleviates NMF. It has strikingly successful effects on sensory, dysautonomic and cognitive fluctuations. However, psychic fluctuations respond less consistently to this treatment.
authors.affiliation: Department of Clinical Neurosciences, University Hospital Timone, Marseille, France. tatiana.witjas@ap-hm.fr
authors.forename: Tatiana
authors.initials: T
authors.lastname: Witjas
authors.forename: Elsa
authors.initials: E
authors.lastname: Kaphan
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jouve
authors.forename: André Ali
authors.initials: AA
authors.lastname: Chérif
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Péragut
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Azulay
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology / Q000628:therapy; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000503:physiopathology* / Q000528:radiation effects