title: Ten-year outcome of subthalamic stimulation in Parkinson disease: a blinded evaluation.
abstract: OBJECTIVE
  To assess the 10-year motor outcome of deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson disease (PD).
  
  
  METHODS
  Patients with PD with bilateral STN-DBS were assessed according to the Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease protocol and videotaped at baseline and 1, 5, and 10 years after surgery. An independent rater blinded to stimulation and medication condition scored the 10-year video assessments.
  
  
  METHODS
  Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto.
  
  
  METHODS
  Eighteen patients with advanced PD and 10-year follow-up of STN-DBS.
  
  
  METHODS
  Bilateral STN-DBS surgery.
  
  
  METHODS
  The primary outcome was the change in blinded Unified Parkinson's Disease Rating Scale (UPDRS) motor scores/subscores between the no medication/stimulation condition vs the no medication/no stimulation condition at 10 years. Secondary outcomes were the changes in blinded UPDRS motor scores between the medication/no stimulation and medication/stimulation conditions, UPDRS II scores, UPDRS IV dyskinesia and motor fluctuations scores, and anti-PD medication dose (levodopa equivalent daily dose) at different points.
  
  
  RESULTS
  In the 18 patients available for follow-up at 10 years, STN-DBS still significantly improved the UPDRS total motor score (P = .007) and resting and action tremor (P < .01 and P = .02, respectively) and bradykinesia (P = .01) subscores. The UPDRS II scores in the medication and no medication conditions, UPDRS IV dyskinesia and motor fluctuations scores, and the levodopa equivalent daily dose were also significantly reduced compared with baseline. Axial signs showed the most progressive decline in stimulation and levodopa response over the years.
  
  
  CONCLUSIONS
  This class III study provides evidence that stimulation-induced motor improvement was sustained overall at 10 years, although part of the initial benefit wore off mainly because of progressive loss of benefit on axial signs over time.
authors.affiliation: Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Castrioto
authors.forename: Andres M
authors.initials: AM
authors.lastname: Lozano
authors.forename: Yu-Yan
authors.initials: YY
authors.lastname: Poon
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
authors.forename: Melanie
authors.initials: M
authors.lastname: Fallis
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods; D020820:Dyskinesias / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D016037:Single-Blind Method; D020531:Subthalamic Nucleus / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording