Gervais-Bernard, H. et al. Bilateral subthalamic nucleus stimulation in advanced Parkinson's disease: five year follow-up. J. Neurol. 256, 225-233

Claude Bernard Lyon I, Université de Lyon, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France.
Journal of Neurology (Impact Factor: 3.38). 03/2009; 256(2):225-33. DOI: 10.1007/s00415-009-0076-2
Source: PubMed


To assess the long-term efficacy and safety of bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson's disease (PD).
42 consecutive patients with idiopathic PD treated with bilateral STN stimulation were enrolled. Parkinsonian status, medication intake and neuropsychological evaluation were assessed preoperatively and at 1 and 5 years postoperatively in on and off medication/on and off stimulation conditions.
23 patients could be followed-up 5 years after surgery. In the remaining cases, 5 died, 1 could not be assessed because of device removal for infection, 1 decided not to be stimulated, and 11 were lost of follow-up (one because of a liver carcinoma and the others because they refused the formal four conditions of assessment). STN stimulation reduced the UPDRS motor score by 55 % compared to baseline in the off-medication conditions. Tremor, rigidity, bradykinesia, postural stability, and gait improved by 74 %, 66 %, 59 %, 17 % and 37 %, respectively. UPDRS part II scores were reduced by 38 %. The dopaminergic treatment daily dose was reduced by 54.4 % after surgery. Axial dopa-unresponsive signs worsened in some patients. Among the 42 initial patients we observed the following: 2 brain hemorrhages, 3 infections of the device, 2 phlebitis and 1 pulmonary embolism. In addition, 2 patients needed a repositioning of the electrode. Among the 23 patients followed at 5 years, long lasting side effects consisted in dysarthria (56 %), depression (39 %), eyelid opening apraxia (30.4 %) and apathy (4.3 %).
Our data confirm that bilateral STN stimulation is beneficial in the long-term for PD patients but does not prevent disease progression and the occurence of axial levodopa unresponsive signs in some patients.

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    • "While several brain regions can be targeted with DBS, the subthalamic nucleus (STN) has proven to be highly effective [4] [5]. In fact, numerous studies have demonstrated the efficacy of STN DBS in reducing PD-related motor symptoms as well as reducing the motor complications associated with drug treatment [4] [5] [6] [7] [8] [9]. Concomitantly, others have demonstrated that STN DBS may also lead to improved QoL [10]. "
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    ABSTRACT: Background: Maintaining a physically active lifestyle promotes general health. Recent studies have demonstrated that patients with Parkinson's disease (PD) fail to meet the suggested levels of physical activity and that targeted interventions do not always improve this behavior. One validated treatment for motor symptoms in PD is subthalamic stimulation (STN DBS). Objective: Assess whether motor symptom improvement following STN DBS translated into increased physical activity behavior. Methods: Twenty-two patients with PD scheduled for STN DBS filled-out the Phone-FITT physical activity questionnaire and the SF-36 quality of life questionnaire prior to surgery and 6 to 9 months postoperatively. Data were compared to age- and gender-matched healthy controls. Results: Our results demonstrate that PD patients' quality of life is significantly lower than healthy controls. While STN DBS improves motor symptoms in the intermediate term, it only improves some aspects of quality of life related to physical function. Furthermore, STN DBS did not modify physical activity behavior measured by the Phone-FITT, whether for household or recreational activities. Conclusion: The current study demonstrates that the motor improvements observed after STN DBS do not lead to systematic improvements in all aspects of quality of life or increased levels of physical activity. This highlights the need to develop and implement intervention strategies to promote an active lifestyle in this population, even if clinical improvement is evident following surgery.
    Journal of Parkinson's Disease 10/2014; 5(1). DOI:10.3233/JPD-140426 · 1.91 Impact Factor
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    • "To date, there is no single explanation for these neuropsychiatric complications: they could depend on both the indirect influence of STN stimulation on the limbic system, including the influence of electrode placement (Strutt et al., 2012), and on the post-operative reduction of dopaminergic therapy. A general consensus has not yet been reached on mood changes after DBS of STN: most studies have reported either no change or an improvement in depression after surgery, while others have reported a worsening of mood state, including suicidal ideation and attempted completed suicide (Gervais-Bernard et al., 2009; Strutt et al., 2012; Weintraub et al., 2013), particularly in patients with a previous history of psychiatric disorder (Lilleeng and Dietrichs, 2008). One study does not support direct association between DBS surgery and increased risk for suicidal ideation and behaviors (Weintraub et al., 2013), while another one highlights that postoperative depression remained a significant factor associated with attempted and completed suicide (Voon et al., 2008). "
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    ABSTRACT: Objectives: To evaluate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on alexithymia, a deficit in affective regulation, comparing patients with Parkinson’s disease (PD) submitted to STN-DBS (DBS group) to PD patients not yet treated with STN-DBS (pre-DBS group) and to healthy participants (C group). Methods: We recruited 27 consecutive STN-DBS PD patients, 38 consecutive pre-DBS patients and 27 healthy participants. Patients were assessed for alexithymia (Toronto Alexithymia Scale), depression, [beck depression inventory (BDI)], and cognitive functions (reasoning, memory, attentional, and executive tests). Results: The DBS patients performed worse than the pre-DBS patients in the corsi’s block-tapping test, in the phonemic fluency task and in the Frontal Assessment Battery. Around 30% of DBS (29.6%) and pre-DBS (31.6%) patients resulted alexithymic, compared with 14.8% in the C group. The results pointed out significantly higher alexithymia scores in both the DBS and pre-DBS groups compared with the C group, while no difference emerged between the DBS and pre-DBS groups. Pre-DBS group showed a significantly higher BDI score than the C group, while DBS group did not. Conclusion: Although the results suggest that STN-DBS does not affect alexithymia, both the DBS and pre-DBS patients reported higher prevalence (about 30%) of alexithymia than did healthy subjects (14.8%).
    Frontiers in Psychology 10/2014; 5(1168). DOI:10.3389/fpsyg.2014.01168 · 2.80 Impact Factor
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    • "In general, STN DBS results in improvement in the motor symptoms of PD2,11,36). In our study, UPDRS part II with medication, UPDRS part III with/without medication, UPDRS part IV, LED, H&Y, and ADL showed improvement after long-term follow-up. "
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    ABSTRACT: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment of choice for patients with advanced idiopathic Parkinson's disease (PD) who have motor complication with medication. The objectives of this study are to analyze long-term follow-up data of STN DBS cases and to identify the factors related to outcomes. Fifty-two PD patients who underwent STN DBS were followed-up for more than 3 years. The Unified Parkinsons Disease Rating Scale (UPDRS) and other clinical profiles were assessed preoperatively and during follow-up. A linear regression model was used to analyze whether factors predict the results of STN DBS. We divided the study individuals into subgroups according to several factors and compared subgroups. Preoperative activity of daily living (ADL) and the magnitude of preoperative levodopa response were shown to predict the improvement in UPDRS part II without medication, and preoperative ADL and levodopa equivalent dose (LED) were shown to predict the improvement in UPDRS part II with medication. In UPDRS part III with medication, the magnitude of preoperative levodopa response was a predicting factor. The intensity of preoperative levodopa response was a strong factor for motor outcome. And preoperative ADL and LED were strong factors for ADL improvement. More vigorous studies should be conducted to elucidate how levodopa-induced motor complications are ameliorated after STN DBS.
    Journal of Korean Neurosurgical Society 08/2013; 54(2):118-24. DOI:10.3340/jkns.2013.54.2.118 · 0.64 Impact Factor
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