Bilateral subthalamic nucleus stimulation in advanced Parkinson's disease: five year follow-up.
OBJECTIVE
To assess the long-term efficacy and safety of bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson's disease (PD).


METHODS
42 consecutive patients with idiopathic PD treated with bilateral STN stimulation were enrolled. Parkinsonian status, medication intake and neuropsychological evaluation were assessed preoperatively and at 1 and 5 years postoperatively in on and off medication/on and off stimulation conditions.


RESULTS
23 patients could be followed-up 5 years after surgery. In the remaining cases, 5 died, 1 could not be assessed because of device removal for infection, 1 decided not to be stimulated, and 11 were lost of follow-up (one because of a liver carcinoma and the others because they refused the formal four conditions of assessment). STN stimulation reduced the UPDRS motor score by 55 % compared to baseline in the off-medication conditions. Tremor, rigidity, bradykinesia, postural stability, and gait improved by 74 %, 66 %, 59 %, 17 % and 37 %, respectively. UPDRS part II scores were reduced by 38 %. The dopaminergic treatment daily dose was reduced by 54.4 % after surgery. Axial dopa-unresponsive signs worsened in some patients. Among the 42 initial patients we observed the following: 2 brain hemorrhages, 3 infections of the device, 2 phlebitis and 1 pulmonary embolism. In addition, 2 patients needed a repositioning of the electrode. Among the 23 patients followed at 5 years, long lasting side effects consisted in dysarthria (56 %), depression (39 %), eyelid opening apraxia (30.4 %) and apathy (4.3 %).


CONCLUSIONS
Our data confirm that bilateral STN stimulation is beneficial in the long-term for PD patients but does not prevent disease progression and the occurence of axial levodopa unresponsive signs in some patients.
Gervais-Bernard
Hélène
H
Claude Bernard Lyon I, Université de Lyon, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France.
Xie-Brustolin
Jing
J
Mertens
Patrick
P
Polo
Gustavo
G
Klinger
Hélène
H
Adamec
Dario
D
Broussolle
Emmanuel
E
Thobois
Stéphane
S
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage; D001767:Blinking / Q000187:drug effects / Q000502:physiology; D046690:Deep Brain Stimulation / Q000379:methods*; D003866:Depressive Disorder / Q000209:etiology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004401:Dysarthria / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000033:anatomy & histology / Q000502:physiology*; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome
D000978:Antiparkinson Agents