Journal Article

Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up

M. C. Rodriguez-Oroz, J. A. Obeso, A. E. Lang, J.-L. Houeto, P. Pollak, S. Rehncrona, J. Kulisevsky, A. Albanese, J. Volkmann, M. I. Hariz, N. P. Quinn, J. D. Speelman, J. Guridi, I. Zamarbide, A. Gironell, J. Molet, B. Pascual-Sedano, B. Pidoux, A. M. Bonnet, Y. Agid, J. Xie, A.-L. Benabid, A. M. Lozano, J. Saint-Cyr, L. Romito, M. F. Contarino, M. Scerrati, V. Fraix and N. Van Blercom

in Brain

Published on behalf of The Guarantors of Brain

Volume 128, issue 10, pages 2240-2249
Published in print October 2005 | ISSN: 0006-8950
Published online June 2005 | e-ISSN: 1460-2156 | DOI: http://dx.doi.org/10.1093/brain/awh571
Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up

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Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6–12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n = 49) or globus pallidus internus (GPi, n = 20) included in a multicentre study. Patients were assessed preoperatively and at 1 year and 3–4 years after surgery. The primary outcome measure was the change in the ‘off’ medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) at 3–4 years. Stimulation of the STN or GPi induced a significant improvement (50 and 39%; P < 0.0001) of the ‘off’ medication UPDRS-III score at 3–4 years with respect to baseline. Stimulation improved cardinal features and activities of daily living (ADL) (P < 0.0001 and P < 0.02 for STN and GPi, respectively) and prolonged the ‘on’ time spent with good mobility without dyskinesias (P < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P < 0.001). Comparison of the improvement induced by stimulation at 1 year with 3–4 years showed a significant worsening in the ‘on’ medication motor states of the UPDRS-III, ADL and gait in both STN and GPi groups, and speech and postural stability in the STN-treated group. Adverse events (AEs) included cognitive decline, speech difficulty, instability, gait disorders and depression. These were more common in patients treated with DBS of the STN. No patient abandoned treatment as a result of these side effects. This experience, which represents the first multicentre study assessing the long-term efficacy of either STN or GPi stimulation, shows a significant and substantial clinically important therapeutic benefit for at least 3–4 years in a large cohort of patients with severe Parkinson's disease.

Keywords: deep brain stimulation; globus pallidus pars interna; long-term effects; Parkinson's disease; subthalamic nucleus; ADL = activities of daily living; AEs = adverse events; DBS = deep brain stimulation; GPi = globus pallidus pars interna; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale

Journal Article.  6600 words.  Illustrated.

Subjects: Neurology ; Neuroscience

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