Staged bilateral deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease.
BACKGROUND
Several investigators have described the efficacy and safety of unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for the treatment of Parkinson's disease (PD). Some patients who underwent unilateral STN DBS required additional surgery on the contralateral side because the unilateral treatment was insufficient. The goal of this study was to assess the efficacy and safety of staged bilateral STN DBS compared to the simultaneous bilateral procedure.


METHODS
Ten patients with medically intractable PD underwent staged bilateral STN DBS, and 12 patients underwent a simultaneous bilateral procedure. Clinical assessments were performed preoperatively and 6 months after the last surgery using the Unified Parkinson's Disease Rating Scale (UPDRS), motor and activity of daily living (ADL) subscores, and Hoehn and Yahr stages.


RESULTS
Both the staged and simultaneous groups experienced significant improvement in the UPDRS motor and ADL scores, and the Hoehn and Yahr stages. There were no statistical differences between the two groups in the percent improvement in UPDRS scores. The rate of adverse events in the staged group (20%) was less than that of the simultaneous group (42%), although the difference was not statistically significant.


CONCLUSIONS
Both the staged bilateral STN DBS and the simultaneous bilateral procedure are effective and safe treatment options, but the staged bilateral procedure may be regarded as the preferred choice for the treatment of some patients.
Tanei
Takafumi
T
Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. nsgtakasyun@msn.com
Kajita
Yasukazu
Y
Kaneoke
Yoshiki
Y
Takebayashi
Shigenori
S
Nakatsubo
Daisuke
D
Wakabayashi
Toshihiko
T
D017668:Age of Onset; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001921:Brain / Q000033:anatomy & histology / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000033:anatomy & histology / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D020531:Subthalamic Nucleus / Q000033:anatomy & histology / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome
D000978:Antiparkinson Agents