title: Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease.
abstract: 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.
authors.affiliation: Toronto Western Hospital, Movement Disorders Center, University of Toronto and University Health Network, Toronto, Ontario, Canada. elena.moro@uhn.on.ca
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.forename: Andres M
authors.initials: AM
authors.lastname: Lozano
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
authors.forename: Yves
authors.initials: Y
authors.lastname: Agid
authors.forename: Stig
authors.initials: S
authors.lastname: Rehncrona
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.forename: Jaime
authors.initials: J
authors.lastname: Kulisevsky
authors.forename: Jose A
authors.initials: JA
authors.lastname: Obeso
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.forename: Marwan I
authors.initials: MI
authors.lastname: Hariz
authors.forename: Niall P
authors.initials: NP
authors.lastname: Quinn
authors.forename: Jans D
authors.initials: JD
authors.lastname: Speelman
authors.forename: Alim L
authors.initials: AL
authors.lastname: Benabid
authors.forename: Valerie
authors.initials: V
authors.lastname: Fraix
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mendes
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Welter
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Houeto
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
authors.forename: Didier
authors.initials: D
authors.lastname: Dormont
authors.forename: Annalena L
authors.initials: AL
authors.lastname: Tornqvist
authors.forename: Ron
authors.initials: R
authors.lastname: Ekberg
authors.forename: Alfons
authors.initials: A
authors.lastname: Schnitzler
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
authors.forename: Lars
authors.initials: L
authors.lastname: Wojtecki
authors.forename: Andres
authors.initials: A
authors.lastname: Gironell
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Oroz
authors.forename: Jorge
authors.initials: J
authors.lastname: Guridi
authors.forename: Anna R
authors.initials: AR
authors.lastname: Bentivoglio
authors.forename: Maria F
authors.initials: MF
authors.lastname: Contarino
authors.forename: Luigi
authors.initials: L
authors.lastname: Romito
authors.forename: Massimo
authors.initials: M
authors.lastname: Scerrati
authors.forename: Marc
authors.initials: M
authors.lastname: Janssens
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
mesh_terms: 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