Article

Long-Term Outcomes of Bilateral Subthalamic Nucleus Stimulation in Patients with Advanced Parkinson’s Disease

The Parkinson's Institute, Sunnyvale, CA, USA.
Stereotactic and Functional Neurosurgery (Impact Factor: 1.48). 11/2006; 84(5-6):221-7. DOI: 10.1159/000096495
Source: PubMed

ABSTRACT In patients with advanced Parkinson's disease (PD), deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been shown to improve motor function and decrease medication requirements in the short term. However, the long-term benefits of DBS are not yet established.
It was the aim of this study to evaluate long-term outcomes of patients with PD treated with bilateral DBS of the STN.
Thirty-three subjects who had bilateral STN DBS were followed prospectively after surgery. We evaluated subjects, using the Unified Parkinson's Disease Rating Scale (UPDRS), preoperatively, 12 months after surgery and at a long-term follow-up visit. Ratings were performed on and off dopaminergic medications. We compared postoperative UPDRS scores, dyskinesia ratings and medication dosages with preoperative values.
Twenty-seven subjects had evaluations beyond 18 months (median 33.7 months). Total UPDRS scores in the 'medication-off' state were improved by 37% (p < 0.001) at 12 months and 17.7% (p = 0.0051) at the long-term evaluation. Medication-off state UPDRS part III scores were significantly improved at both 1 year and at the last evaluation (37.6 and 29.3%; p < 0.001). Dopaminergic medication requirements were decreased by 35.3% (p < 0.001) during the first postoperative year and remained below preoperative levels at the long-term evaluation. Average duration of 'off' time remained decreased by about 40% at both 1 year and at the time of last evaluation. Subjects had a sustained reduction in dyskinesia severity (88.6% at 1 year and 68.8% at last evaluation).
In this cohort of subjects with advanced PD, bilateral STN stimulation improved 'off' medication motor function, reduced time spent in the medication-off state and reduced medication requirements for up to 4 years after surgery. We conclude that STN DBS is an effective long-term therapy for selected patients with advanced PD.

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    • "The principle of neural stimulation is to restore the physiological function/s of the nerves or muscles by targeted and controlled delivery of electrical stimulation to the affected areas (Castrioto, 2011). Deep Brain Stimulation (DBS) has been used on the patients in the later stage of PD that pharmacological treatments offer them little to nothing and it has certainly improved locomotive ability and to some extent cognitions in patients with PD without dementia (Krack, 2003) (Liang, 2006). "
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    ABSTRACT: The technology of Neural Stimulation in recent years has become the focus of the research and treatment, although it has been around for many years. The potential use of stimulating the brain and nerves ranges from the spinal cord stimulation to the implantations of cochlear and bionic eyes with a large discrepancy between the clinical readiness for these various uses. Electrical high-frequency Deep Brain Stimulation (DBS) was developed as an alternative option to treat a few neurological disorders. However, with advancing in surgical procedures, technologies and safeties, the applications of DBS are expanding not only for therapeutic purposes but also for research. Although the exact mechanisms of action/s are not fully understood, the outcome of the ongoing research and clinical trials are promising. DBS has been used to treat the essential tremor since 1997, Parkinson's disease (PD) since 2002 and dystonia since 2003. It has also been used to treat various disorders, including major depression. The therapeutic effect of DBS in PD is well established but for other diseases such as epilepsy the outcomes are unclear and ambiguous. This article is a succinct review of the literature, focusing on PD, epilepsy and Obsessive Compulsive Disorder (OCD).
    Autonomic neuroscience: basic & clinical 08/2013; 4(3):84-88. · 1.37 Impact Factor
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    • "Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established surgical therapy for Parkinson disease (PD) [1]. It can control the main motor symptoms of PD (tremor, rigidity and bradykinesia) for many years as well as reduce motor fluctuations and dyskinesias [2] [3]. Though control of motor symptoms is the main goal of DBS, non-motor symptoms of the disease and their contribution to poor quality of life have been increasingly recognized in recent years [4e6]. "
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    ABSTRACT: The Movement Disorders Society revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) improves upon the original UPDRS by adding more non-motor items, making it a more robust tool to evaluate the severity of motor and non-motor symptoms of Parkinson disease. Previous studies on deep brain stimulation have not used the MDS-UPDRS. To determine if the MDS-UPDRS could detect improvement in both motor and non-motor symptoms after bilateral subthalamic nucleus deep brain stimulation for Parkinson disease. We compared scores on the entire MDS-UPDRS prior to surgery (baseline) and approximately six months following the initial programming visit in twenty subjects (12M/8F) with Parkinson disease undergoing bilateral subthalamic nucleus deep brain stimulation. STN DBS significantly improved the scores for every section of the MDS-UPDRS at the 6 month follow-up. Part I improved by 3.1 points (22%), Part II by 5.3 points (29%), Part III by 13.1 points (29%) with stimulation alone, and Part IV by 7.1 points (74%). Individual non-motor items in Part I that improved significantly were constipation, light-headedness, and fatigue. Both motor and non-motor symptoms, as assessed by the MDS-UPDRS, improve with bilateral subthalamic nucleus stimulation six months after the stimulator is turned on. We recommend that the MDS-UPDRS be utilized in future deep brain stimulation studies because of the advantage of detecting change in non-motor symptoms.
    Parkinsonism & Related Disorders 07/2013; 19(11). DOI:10.1016/j.parkreldis.2013.06.010 · 4.13 Impact Factor
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    • "All rights reserved symptoms of PD. Many studies have demonstrated that bilateral STN stimulation improves " off " medication motor function, reduces time spent in the medication-off state, reduces medication requirements and improves motor scores on the Unified Parkinson's Disease Rating Scale (UPDRS III) both in the short term [1] [2] [3], and as long as nine years post implantation [4] [5] [6] [7] [8] [9]. While the degree of improvement varies between studies [10] [11], there is an emerging consensus that bilateral STN DBS improves quality of life in PD [1] [3] [12] [13]. "
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    ABSTRACT: Deep brain stimulation (DBS) of the subthalamic nucleus improves the motor symptoms of Parkinson's disease, but may produce a worsening of speech and language performance at rates and amplitudes typically selected in clinical practice. The possibility that these dissociated effects might be modulated by selective stimulation of left and right STN has never been systematically investigated. To address this issue, we analyzed motor, speech and language functions of 12 patients implanted with bilateral stimulators configured for optimal motor responses. Behavioral responses were quantified under four stimulator conditions: bilateral DBS, right-only DBS, left-only DBS and no DBS. Under bilateral and left-only DBS conditions, our results exhibited a significant improvement in motor symptoms but worsening of speech and language. These findings contribute to the growing body of literature demonstrating that bilateral STN DBS compromises speech and language function and suggests that these negative effects may be principally due to left-sided stimulation. These findings may have practical clinical consequences, suggesting that clinicians might optimize motor, speech and language functions by carefully adjusting left- and right-sided stimulation parameters.
    01/2012; 2(1):29-40. DOI:10.3233/JPD-2012-11049
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