Microsubthalamotomy improves sleep in patients affected by advanced Parkinson's disease.
BACKGROUND
Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves sleep in patients affected by Parkinson's disease (PD). Since microsubthalamotomy (mSTN) shows positive effects on motor symptoms, it could improve sleep in PD patients. Our goals were: to assess the effects of mSTN on sleep in patients affected by advanced PD; and to look for a correlation between sleep and motor features after the neurosurgical procedure.


METHODS
Fifteen patients who underwent bilateral STN-DBS were enrolled. Subjective sleep evaluation was assessed using the Parkinson's Disease Sleep Scale (PDSS). Data on sleep schedule and presence of restless legs syndrome (RLS) were obtained. Objective sleep features were investigated by polysomnography (PSG). To evaluate the mSTN effect, we compared motor state and sleep features before and after the neurosurgical procedure, before the programmable pulse generator was switched on.


RESULTS
mSTN had beneficial effects on motor state and sleep features. After the surgery, the mean total PDSS score increased from 84.0±25.2 to 115.2±16.6 (P<0.001). PD patients reported longer total sleep time duration, decreased daytime sleepiness, and improvement in RLS symptoms. PSG data showed an increase in total sleep time and sleep efficiency with a decrease in wakefulness after sleep onset and arousal index. No correlation between motor improvements and sleep features modifications was observed after mSTN.


CONCLUSIONS
mSTN improves sleep quality and ameliorates several sleep complaints, as well as motor symptoms, in advanced PD patients who have undergone STN-DBS.
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy. Electronic address: merlinogiovanni.work@libero.it.
Giovanni
G
Merlino
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Christian
C
Lettieri
Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Massimo
M
Mondani
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Enrico
E
Belgrado
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Grazia
G
Devigili
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Marco
M
Mucchiut
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Sara
S
Rinaldo
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Chiara
C
Craighero
Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Stanislao
S
D'Auria
Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Miran
M
Skrap
Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Roberto
R
Eleopra
D046690:Deep Brain Stimulation; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D017286:Polysomnography; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D020531:Subthalamic Nucleus / Q000601:surgery*
Deep brain stimulation; Microsubthalamotomy; Parkinson’s disease; Polysomnography; Restless legs syndrome; Sleep