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

Moro, Elena
Lozano, Andres M
Agid, Yves
Rehncrona, Stig
Volkmann, Jens
Kulisevsky, Jaime
Obeso, Jose A
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Published in Movement Disorders. 2010, vol. 25, no. 5, p. 578-86
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 AgedCross-Over StudiesDeep Brain StimulationDouble-Blind MethodFemaleFollow-Up StudiesGlobus Pallidus/physiologyHumansMaleMiddle AgedParkinson Disease/therapySeverity of Illness IndexSubthalamus/physiologyTime FactorsTreatment Outcome
PMID: 20213817
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Research group Maladie de Parkinson (911)
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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. 578-86. https://archive-ouverte.unige.ch/unige:32883

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Deposited on : 2014-01-07

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