title: Subthalamic nucleus stimulation applied in the earlier vs. advanced stage of Parkinson's disease - retrospective evaluation of postoperative independence in pursuing daily activities.
abstract: While bilateral stimulation of the subthalamic nucleus (STN) has been commonly applied for patients with advanced Parkinson's disease (PD), surgery in the earlier stage of the disease may yield a better prognosis. We retrospectively analyzed the pre- and postoperative activities of daily living (ADL) of 38 PD patients who had undergone bilateral STN stimulation 3 months earlier. Preoperative Unified Parkinson's Disease Rating Scale (UPDRS) scores for neuropsychiatric, axial and ADL impairments were negatively correlated with the postoperative Schwab & England ADL (S-E) scale in the off-medication status (p < 0.01). Patients with longer disease duration had a lower postoperative S-E scale, but their correlation was not statistically significant (p = 0.0467). Age was not a significant predictor of postoperative ADL. Patients with a preoperative on-medication S-E scale <or=60% (n=14) manifested a greater response rate to surgery than did those with a preoperative S-E scale >or=70% (n=24). However, patients with poorer preoperative ADL were unable to perform ADL independently after surgery (postoperative S-E was 70.0 +/- 12.4% in the on-, and 65.7 +/- 16.0% in the off-medication status) and the difference from patients with better preoperative S-E was significant (postoperative S-E 92.5 +/- 5.3% in the on-, and 90.4 +/- 6.2% in the off-medication status) (p < 0.0001). Our findings suggest that the delivery of STN stimulation earlier in the course of PD may result in greater independence in postoperative ADL.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan. yamadakazu@fc.kuh.kumamoto-u.ac.jp
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yamada
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hamasaki
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kuratsu
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology*
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa