Beyond nine years of continuous subthalamic nucleus deep brain stimulation in Parkinson's disease.
Deep brain stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease. The benefits of bilateral subthalamic stimulation are well documented, and some studies reported outcomes with a follow-up of 5 to 6 years; nevertheless, few data are available beyond 5 years. We report a long-term prospective evaluation of 14 consecutive parkinsonian patients, treated by bilateral subthalamic stimulation for at least 9 years. Motor symptoms, activity of daily living, and motor complications were evaluated by means of the Unified Parkinson's Disease Rating Scale, while cognition and mood were assessed with a specific neuropsychological test battery; medication intake, stimulation parameters, comorbidity, and adverse events were also recorded. Patients were evaluated before surgery and at 1, 5, and ≥ 9 years after surgery. At last follow-up, deep brain stimulation significantly improved the motor score by 42% compared to baseline, whereas activities of daily living were no longer improved; there was a 39% reduction in the dosage of dopaminergic drugs and a 59% improvement of L-dopa-related motor complications. The neuropsychological assessment showed that 4 patients (29%) developed a significant cognitive decline over the follow-up period. These results indicate a persistent effect of deep brain stimulation of the subthalamic nucleus on the cardinal motor symptoms in advanced Parkinson's disease patients in the long-term; however, a worsening of patients' disability, mainly due to disease progression, was observed.
Department of Neuroscience, University of Torino, Torino, Italy. maurizio.zibetti@gmail.com
Maurizio
M
Zibetti
Aristide
A
Merola
Laura
L
Rizzi
Valeria
V
Ricchi
Serena
S
Angrisano
Corrado
C
Azzaro
Carlo Alberto
CA
Artusi
Nichy
N
Arduino
Alice
A
Marchisio
Michele
M
Lanotte
Mario
M
Rizzone
Leonardo
L
Lopiano
D000203:Activities of Daily Living; D000368:Aged; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D018450:Disease Progression; D015259:Dopamine Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
D015259:Dopamine Agents