title: Subthalamic nucleus deep brain stimulation for Parkinson's disease: evidence for effectiveness and limitations from 12 years' experience.
abstract: OBJECTIVE
  To present the result and experience of subthalamic nucleus deep brain stimulation for Parkinson's disease.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Prince of Wales Hospital, Hong Kong.
  
  
  METHODS
  A cohort of patients with Parkinson's disease received subthalamic nucleus deep brain stimulation from September 1998 to January 2010. Patient assessment data before and after the operation were collected prospectively.
  
  
  RESULTS
  Forty-one patients (21 male and 20 female) with Parkinson's disease underwent bilateral subthalamic nucleus deep brain stimulation and were followed up for a median interval of 12 months. For the whole group, the mean improvements of Unified Parkinson's Disease Rating Scale (UPDRS) parts II and III were 32.5% and 31.5%, respectively (P<0.001). Throughout the years, a multidisciplinary team was gradually built. The deep brain stimulation protocol evolved and was substantiated by updated patient selection criteria and outcome assessment, integrated imaging and neurophysiological targeting, refinement of surgical technique as well as the accumulation of experience in deep brain stimulation programming. Most of the structural improvement occurred before mid-2005. Patients receiving the operation before June 2005 (19 cases) and after (22 cases) were compared; the improvements in UPDRS part III were 13.2% and 55.2%, respectively (P<0.001). There were three operative complications (one lead migration, one cerebral haematoma, and one infection) in the group operated on before 2005. There was no operative mortality.
  
  
  CONCLUSIONS
  The functional state of Parkinson's disease patients with motor disabilities refractory to best medical treatment improved significantly after subthalamic nucleus deep brain stimulation. A dedicated multidisciplinary team building, refined protocol for patient selection and assessment, improvement of targeting methods, meticulous surgical technique, and experience in programming are the key factors contributing to the improved outcome.
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Anne Y Y
authors.initials: AY
authors.lastname: Chan
authors.affiliation: Division of Neurology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong.
authors.forename: Jonas H M
authors.initials: JH
authors.lastname: Yeung
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Vincent C T
authors.initials: VC
authors.lastname: Mok
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Vincent H L
authors.initials: VH
authors.lastname: Ip
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: Neurological Institutes of New York, Columbia University, United States.
authors.forename: S H
authors.initials: SH
authors.lastname: Kuo
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Danny T M
authors.initials: DT
authors.lastname: Chan
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: X L
authors.initials: XL
authors.lastname: Zhu
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Edith
authors.initials: E
authors.lastname: Wong
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Claire K Y
authors.initials: CK
authors.lastname: Lau
authors.affiliation: Department of Occupational Therapy, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Rosanna K M
authors.initials: RK
authors.lastname: Wong
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong.
authors.forename: Venus
authors.initials: V
authors.lastname: Tang
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Christine
authors.initials: C
authors.lastname: Lau
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: W S
authors.initials: WS
authors.lastname: Poon
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D046690:Deep Brain Stimulation; D005260:Female; D006723:Hong Kong; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D011183:Postoperative Complications; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
keywords: Deep brain stimulation; Parkinson disease; Subthalamic nucleus