Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease.
We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-five STN patients and 16 GPi patients were assessed at 5 to 6 years after DBS surgery. Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN, P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with off-stimulation, regardless of the sequence of stimulation. In open assessment, both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN, P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group. These results confirm the long-term efficacy of STN and GPi DBS in advanced PD. Although the surgical targets were not randomized, there was a trend to a better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group.
Moro
Elena
E
Toronto Western Hospital, Movement Disorders Center, University of Toronto and University Health Network, Toronto, Ontario, Canada. elena.moro@uhn.on.ca
Lozano
Andres M
AM
Pollak
Pierre
P
Agid
Yves
Y
Rehncrona
Stig
S
Volkmann
Jens
J
Kulisevsky
Jaime
J
Obeso
Jose A
JA
Albanese
Alberto
A
Hariz
Marwan I
MI
Quinn
Niall P
NP
Speelman
Jans D
JD
Benabid
Alim L
AL
Fraix
Valerie
V
Mendes
Alexandre
A
Welter
Marie-Laure
ML
Houeto
Jean-Luc
JL
Cornu
Philippe
P
Dormont
Didier
D
Tornqvist
Annalena L
AL
Ekberg
Ron
R
Schnitzler
Alfons
A
Timmermann
Lars
L
Wojtecki
Lars
L
Gironell
Andres
A
Rodriguez-Oroz
Maria C
MC
Guridi
Jorge
J
Bentivoglio
Anna R
AR
Contarino
Maria F
MF
Romito
Luigi
L
Scerrati
Massimo
M
Janssens
Marc
M
Lang
Anthony E
AE
D000368:Aged; D018592:Cross-Over Studies; D046690:Deep Brain Stimulation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D012720:Severity of Illness Index; D020530:Subthalamus / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome