Advanced

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

Rodriguez-Oroz, M C; Obeso, J A; Lang, A E; Houeto, J L; Pollak, P; Rehncrona, Stig LU ; Kulisevsky, J; Albanese, A; Volkmann, J and Hariz, M I, et al. (2005) In Brain 128(10). p.2240-2249
Abstract
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Parkinson's disease, globus pallidus pars interna, deep brain stimulation, effects, long-term, subthalamic nucleus
in
Brain
volume
128
issue
10
pages
2240 - 2249
publisher
Oxford University Press
external identifiers
  • wos:000232278600004
  • pmid:15975946
  • scopus:26044468127
ISSN
1460-2156
DOI
10.1093/brain/awh571
language
English
LU publication?
yes
id
180f1d24-10b2-45f8-8440-4a04a6b06955 (old id 222331)
date added to LUP
2007-08-07 08:48:44
date last changed
2017-11-19 03:25:41
@article{180f1d24-10b2-45f8-8440-4a04a6b06955,
  abstract     = {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 &lt; 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 &lt; 0.0001 and P &lt; 0.02 for STN and GPi, respectively) and prolonged the 'on' time spent with good mobility without dyskinesias (P &lt; 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P &lt; 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.},
  author       = {Rodriguez-Oroz, M C and Obeso, J A and Lang, A E and Houeto, J L and Pollak, P and Rehncrona, Stig and Kulisevsky, J and Albanese, A and Volkmann, J and Hariz, M I and Quinn, N P and Speelman, J D and Guridi, J and Zamarbide, I and Gironell, A and Molet, J and Pascual-Sedano, B and Pidoux, B and Bonnet, A M and Agid, Y and Xie, J and Benabid, A L and Lozano, A M and Saint-Cyr, J and Romito, L and Contarino, M F and Scerrati, M and Fraix, V and Van Blercom, N},
  issn         = {1460-2156},
  keyword      = {Parkinson's disease,globus pallidus pars interna,deep brain stimulation,effects,long-term,subthalamic nucleus},
  language     = {eng},
  number       = {10},
  pages        = {2240--2249},
  publisher    = {Oxford University Press},
  series       = {Brain},
  title        = {Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up},
  url          = {http://dx.doi.org/10.1093/brain/awh571},
  volume       = {128},
  year         = {2005},
}