title: Pallidal stimulation in advanced Parkinson's patients with contraindications for subthalamic stimulation.
abstract: The aim of this study was to evaluate the efficacy and safety of bilateral pallidal (GPi) deep brain stimulation (DBS) 6 months after surgery in advanced parkinsonian patients whose dopa-resistant axial motor signs or cognitive decline constituted contraindications for subthalamic nucleus (STN) DBS. Seventeen patients with a mean age of 59.3 ± 7.1 years (range, 45-70), mean disease duration of 12.5 ± 4.3 years (range, 7-20), and contraindications for STN DBS, underwent bilateral GPi DBS. They were evaluated before surgery and 6 months afterward, in accordance with Core Assessment Program for Intracerebral Transplantation recommendations. There were mean improvements of 41.1% in the UPDRS III motor score in the off-dopa condition and 20.3% in the activities of daily living score. Motor fluctuations were reduced by 22.9% and dyskinesias by 68.6%. Axial motor signs improved in the off-dopa condition by 34.2%. Neuropsychological performances remained unchanged at the 6-month assessment. Bilateral GPi DBS is both safe and effective in advanced parkinsonian patients with untreatable motor fluctuations, for whom STN DBS is contraindicated due to dopa-resistant axial motor signs or cognitive decline. As such, it should be regarded as a viable option for these patients.
authors.affiliation: Department of Neurology, University Hospital of Rennes, Rennes, France.
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Rouaud
authors.forename: Thibaut
authors.initials: T
authors.lastname: Dondaine
authors.forename: Sophie
authors.initials: S
authors.lastname: Drapier
authors.forename: Claire
authors.initials: C
authors.lastname: Haegelen
authors.forename: François
authors.initials: F
authors.lastname: Lallement
authors.forename: Julie
authors.initials: J
authors.lastname: Péron
authors.forename: Sylvie
authors.initials: S
authors.lastname: Raoul
authors.forename: Paul
authors.initials: P
authors.lastname: Sauleau
authors.forename: Marc
authors.initials: M
authors.lastname: Vérin
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000628:therapy*; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000601:surgery*; D016896:Treatment Outcome