Effect of unilateral subthalamic deep brain stimulation in highly asymmetrical Parkinson’s disease: 7-year follow-up

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OBJECTIVE

For patients with highly asymmetrical Parkinson’s disease (PD), unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) has been suggested as a reasonable treatment. However, the results of a previous 2-year follow-up study involving patients with prominently asymmetrical PD who had unilateral STN DBS suggested that simultaneous bilateral surgery should be performed. In the present study, the authors analyze 7-year follow-up data from the same patient group to examine changes in motor benefit from unilateral STN DBS over time and the interval between initial unilateral surgery and a second (contralateral) STN DBS surgery.

METHODS

Eight patients with highly asymmetrical parkinsonism who underwent unilateral STN DBS were evaluated. The factors measured were scores on the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS III), Hoehn and Yahr (HY) stage, and levodopa equivalent daily dose (LEDD). Evaluations occurred at 3, 6, and 12 months after the initial surgery and annually thereafter.

RESULTS

The mean follow-up period was 91.5 months (range 36–105 months). Three years after the initial unilateral surgery, motor benefits on the contralateral side continued; however, an aggravation of the ipsilateral parkinsonism attenuated the improvement in total UPDRS III scores, which reverted to baseline. Axial motor score, LEDD, and HY stage did not differ from the baseline. Seven of 8 patients (87.5%) were considered candidates for a second surgery to offer additional motor benefits. Of the 7 candidates, 4 patients (50% of total patients) underwent the second surgery at 58.5 ± 11.6 (mean ± SD) months after the initial surgery. Three patients were not able to have the second surgery: one patient died of gastric cancer, one patient was severely immobilized by an accident, and one patient could not afford the second surgery. One patient remained content with the initial unilateral surgery throughout the follow-up period.

CONCLUSIONS

Seven of 8 patients with unilateral STN DBS became candidates for second surgery before battery replacement surgery of the first implanted device. Baseline asymmetry alone may not predict appropriate candidates for unilateral STN DBS. This study provides further evidence that, from a long-term perspective, initial simultaneous bilateral STN DBS should be considered for PD patients with prominently asymmetrical motor symptoms.

ABBREVIATIONS DBS = deep brain stimulation; HY = Hoehn and Yahr; LEDD = levodopa equivalent daily dose; PD = Parkinson’s disease; PIGD = postural instability/gait disturbance; STN = subthalamic nucleus; UPDRS III = Unified Parkinson’s Disease Rating Scale Part III.
Article Information

Contributor Notes

Correspondence Beomseok Jeon: Seoul National University, Seoul, Korea. brain@snu.ac.kr.INCLUDE WHEN CITING Published online November 23, 2018; DOI: 10.3171/2018.5.JNS172006.Disclosures B.J. reports research grants from the Ministry of Health and Welfare, Seoul National University Hospital, Sinyang Cultural Foundation, Korean Movement Disorder Society, Boryung Pharm., Novartis Korea, Ipsen Korea, Samil Pharmaceuticals, Abbvie Korea, UCB Korea, Lundbeck Korea, and Sandoz Korea; travel grants from the Korea Research-Based Pharmaceutical Industry Association, Korean Pharmaceutical Manufacturers Association, Seoul National University, and Seoul National University Hospital. Han-Joon Kim reports a research grant from Seoul National University Hospital and the Ministry of Education, Republic of Korea. S.H.P. reports research grants from the Korea Institute of Planning & Evaluation for Technology in Food, Agriculture, Forestry, and Fisheries; Korea Healthcare Technology R&D Project; Ministry of Health & Welfare; Industrial Strategic Technology Development Program 10050154; Bio & Medical Technology Development Program of the NRF funded by the Korean government; MSIP; and Basic Medical Science and Clinical Science, Seoul National University College of Medicine (800-20160093).
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