title: Exhaustive, one-year follow-up of subthalamic nucleus deep brain stimulation in a large, single-center cohort of parkinsonian patients.
abstract: OBJECTIVE
  To prospectively assess the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) at 12 months after surgery in a series of 100 consecutive patients treated in a single center. The primary objective was to describe the clinical outcome in terms of efficacy and tolerance in STN-DBS patients. A secondary objective was to discuss presurgery clinical characteristics a posteriori as a function of outcome.
  
  
  METHODS
  One hundred and three consecutive patients with severe Parkinson's disease received bilateral STN-DBS in our clinic between May 1998 and March 2003. Clinical assessment was performed before and 12 months after surgery and was based on the Unified Parkinson's Disease Rating Scale, Parts II, III, and IV A; the Schwab and England Scale; and cognitive evaluation. Patient-rated overall improvement was also evaluated.
  
  
  RESULTS
  Twelve months after surgery, the Unified Parkinson's Disease Rating Scale Part III score decreased by 43%, the Unified Parkinson's Disease Rating Scale Part II score (activities of daily living) fell by 34%, and the severity of dyskinesia-related disability decreased by 61%. The main surgical complications after STN-DBS were as follows: infection (n = 7), intracerebral hematoma (n = 5), electrode fracture (n = 4), and incorrect lead placement (n = 8). We observed cognitive decline and depression in 7.7 and 18% of the patients, respectively. The mean patient-rated overall improvement score was 70.7%.
  
  
  CONCLUSIONS
  The efficacy and safety of STN-DBS in our center's large cohort of Parkinsonian patients are generally similar to the results obtained by other groups, albeit at the lower limit of the range of reported values. In contrast to efficacy, the occurrence of adverse events cannot be predicted. Younger patients with Parkinson's disease (i.e., those younger than 60 yr) often show an excellent response to levodopa. However, in view of our data on overall patient satisfaction and the occurrence of adverse events, we suggest that older patients (but not those older than 70 yr) and less dopa-sensitive patients (but not those with a response <50%) should still be offered the option of STN-DBS.
authors.affiliation: Department of Neurology, Salengro Hospital, Lille University Medical Centre, Lille, France.
authors.forename: Melissa
authors.initials: M
authors.lastname: Tir
authors.forename: David
authors.initials: D
authors.lastname: Devos
authors.forename: Serge
authors.initials: S
authors.lastname: Blond
authors.forename: Gustavo
authors.initials: G
authors.lastname: Touzet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Reyns
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Olivier
authors.initials: O
authors.lastname: Cottencin
authors.forename: Kathy
authors.initials: K
authors.lastname: Dujardin
authors.forename: François
authors.initials: F
authors.lastname: Cassim
authors.forename: Alain
authors.initials: A
authors.lastname: Destée
authors.forename: Luc
authors.initials: L
authors.lastname: Defebvre
authors.forename: Pierre
authors.initials: P
authors.lastname: Krystkowiak
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage; D015331:Cohort Studies; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging / Q000502:physiology*
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa