Bilateral stimulation of the subthalamic nucleus in patients with Parkinson disease: a study of efficacy and safety

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Object. Palliative neurosurgery has reemerged as a valid therapy for patients with advanced Parkinson disease (PD) that is complicated by severe motor fluctuations. Despite great enthusiasm for long-term deep brain stimulation (DBS) of the subthalamic nucleus (STN), existing reports on this treatment are limited. The present study was designed to investigate the safety and efficacy of bilateral stimulation of the STN for the treatment of PD.

Methods. In 12 patients with severe PD, electrodes were stereotactically implanted into the STN with the assistance of electrophysiological conformation of the target location. All patients were evaluated preoperatively during both medication-off and -on conditions, as well as postoperatively at 3, 6, and 12 months during medication-on and -off states and stimulation-on and -off conditions. Tests included assessments based on the Unified Parkinson's Disease Rating Scale (UPDRS) and timed motor tests.

The stimulation effect was significant in patients who were in the medication-off state, resulting in a 47% improvement in the UPDRS Part III (Motor Examination) score at 12 months, compared with preoperative status. The benefit was stable for the duration of the follow-up period. Stimulation produced no additional benefit during the medication-on state, however, when compared with patient preoperative status. Significant improvements were made in reducing dyskinesias, fluctuations, and duration of off periods.

Conclusions. This study demonstrates that DBS of the STN is an effective treatment for patients with advanced, medication-refractory PD. Deep brain stimulation of the STN produced robust improvements in motor performance in these severely disabled patients while they were in the medication-off state. Serious adverse events were common in this cohort; however, only two patients suffered permanent sequelae.

Article Information

Address reprint requests to: Jurg L. Jaggi, Ph.D., Department of Neurology, University of Pennsylvania, 3 Gates Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. email: jaggi@mail.med.upenn.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bar graph demonstrating UPDRS motor scores (means ± standard error of the means [SEMs]) obtained preoperatively and at 3, 6, and 12 months following surgery. A reduction in scores reflects improvement. Off-off indicates no medication and no stimulation; Sx and Rx indicate stimulation and medication, respectively. Rx + Sx indicate combined therapy. Asterisks are used to note significance (p < 0.001) for comparison to the off-off condition at the same follow-up session.

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    Graph depicting UPDRS motor scores (means ± SEMs) plotted preoperatively and at 3, 6, and 12 months following surgery for medication-off and -on states. Postoperatively, stimulators were turned on for all examinations. Asterisks indicate significance (p < 0.001) for comparison to the patient's preoperative condition.

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    Bar graph demonstrating UPDRS ADL scores (means ± SEMs) evaluated preoperatively and at 3, 6, and 12 months following surgery. A reduction in scores reflects improvement. Asterisks indicate significance (p < 0.005) of stimulation alone compared with combined therapy at the same follow-up session.

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