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Beyond nine years of continuous subthalamic nucleus deep brain stimulation in Parkinson's disease

✍ Scribed by Maurizio Zibetti; Aristide Merola; Laura Rizzi; Valeria Ricchi; Serena Angrisano; Corrado Azzaro; Carlo Alberto Artusi; Nichy Arduino; Alice Marchisio; Michele Lanotte; Mario Rizzone; Leonardo Lopiano

Publisher
John Wiley and Sons
Year
2011
Tongue
English
Weight
385 KB
Volume
26
Category
Article
ISSN
0885-3185

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✦ Synopsis

Abstract

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 β‰₯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. Β© 2011 Movement Disorder Society

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