en
Scientific article
English

Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease

Published inMovement disorders, vol. 25, no. 5, p. 578-586
Publication date2010
Abstract

We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-five STN patients and 16 GPi patients were assessed at 5 to 6 years after DBS surgery. Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN, P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with off-stimulation, regardless of the sequence of stimulation. In open assessment, both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN, P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group. These results confirm the long-term efficacy of STN and GPi DBS in advanced PD. Although the surgical targets were not randomized, there was a trend to a better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group.

Keywords
  • Aged
  • Cross-Over Studies
  • Deep Brain Stimulation
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Globus Pallidus/physiology
  • Humans
  • Male
  • Middle Aged
  • Parkinson Disease/therapy
  • Severity of Illness Index
  • Subthalamus/physiology
  • Time Factors
  • Treatment Outcome
Citation (ISO format)
MORO, Elena et al. Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson’s disease. In: Movement disorders, 2010, vol. 25, n° 5, p. 578–586. doi: 10.1002/mds.22735
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Article (Published version)
accessLevelRestricted
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ISSN of the journal0885-3185
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