title: Pallidal stimulation in Parkinson's patients with contraindications to subthalamic target: A 3 years follow-up.
abstract: Over a 3-year period, we monitored the efficacy and safety of deep-brain stimulation of the globus pallidus pars interna in patients with advanced Parkinson's disease whose cognitive, psychiatric impairment and/or dopa-resistant axial motor signs made them ineligible for surgery targeting the subthalamic nucleus.
  
  
  
  A total of 25 patients were assessed before surgery, 1 year and 3 years after surgery, on the UPDRS and a neuropsychological battery.
  
  
  
  We noted a significant improvement of 65.9% in the Clinical global self-perceived Improvement by Visual Analog Scale and an improvement of 20.6% in the total UPDRS-III motor score at 3 years in the off-dopa condition compared to before surgery. There was an improvement in the treatment's motor complications, as measured by the UPDRS-IV, with a particularly marked reduction of 50% in the Dyskinesia subscore. Cognitive performances remained stable at 1 year but had fallen by the third year. We interpreted this deterioration as due to disease progression.
  
  
  
  Bilateral pallidal stimulation in patients with contraindications to subthalamic surgery therefore seems to be effective over the long term in treating motor symptoms, especially dyskinesias, with good neuropsychological safety.
authors.affiliation: Department of Neurology, University Hospital of Rennes, 35043 Rennes, France. Electronic address: julien.bonenfant@chu-rennes.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Bonenfant
authors.affiliation: Department of Neurology, University Hospital of Rennes, 35043 Rennes, France; "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Drapier
authors.affiliation: Department of Neurology, University Hospital of Rennes, 35043 Rennes, France; "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Houvenaghel
authors.affiliation: Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Rennes University Hospital, 35033 Rennes, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Naudet
authors.affiliation: Department of Neurosurgery, Rennes University Hospital, 35033 Rennes, France; "MediCIS" Laboratory (UMR 1099 LTSI), INSERM/University of Rennes 1, Rennes, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Haegelen
authors.affiliation: "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France; Department of Neurophysiology, Rennes University Hospital, F-35033 Rennes, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Sauleau
authors.affiliation: Department of Neurology, University Hospital of Rennes, 35043 Rennes, France; "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France. Electronic address: marc.verin@chu-rennes.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Vérin
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy; D000075202:Contraindications; D046690:Deep Brain Stimulation / Q000379:methods*; D004409:Dyskinesia, Drug-Induced / Q000628:therapy; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009493:Neurosurgery / Q000379:methods; D010300:Parkinson Disease / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D064232:Visual Analog Scale
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Axial motor symptoms; Deep brain stimulation; Neuropsychological outcome; Pallidal stimulation; Parkinson's disease