Two-year follow-up on the effect of unilateral subthalamic deep brain stimulation in highly asymmetric Parkinson's disease.
Although bilateral subthalamic deep brain stimulation (STN DBS) provides greater relief from the symptoms of Parkinson's disease (PD) than unilateral STN DBS, it has been suggested that unilateral STN DBS may be a reasonable treatment option in selected patients, especially those with highly asymmetric PD. In previous studies on the effect of unilateral STN DBS, the asymmetry of PD symptoms was not prominent and the mean follow-up durations were only 3 to 12 months. In this study, we report our findings in a series of 8 patients with highly asymmetric PD who were treated with unilateral STN DBS and were followed for 24 months. Serial changes in Unified Parkinson's Disease Rating Scale (UPDRS) motor score and subscores in the ipsilateral, contralateral, and axial body parts were analyzed. Unilateral STN DBS improved the UPDRS motor score and the contralateral subscore in the on-medication state for 5 nonfluctuating patients and in the off-medication state for 3 fluctuating patients. However, the ipsilateral subscore progressively worsened and reversed asymmetry became difficult to manage, which led to compromised medication and stimulator adjustment. At 24 months, all the patients were considering the second-side surgery. Our results suggest that bilateral STN DBS should be considered even in highly asymmetric PD.
Kim
Han-Joon
HJ
Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, Korea.
Paek
Sun Ha
SH
Kim
Ji-Young
JY
Lee
Jee-Young
JY
Lim
Yong Hoon
YH
Kim
Dong Gyu
DG
Jeon
Beom S
BS
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000379:methods*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D018476:Hypokinesia / Q000175:diagnosis / Q000453:epidemiology; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D011182:Postoperative Care; D011187:Posture; D011300:Preoperative Care; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014202:Tremor / Q000175:diagnosis / Q000453:epidemiology
D000978:Antiparkinson Agents; D007980:Levodopa