Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson’s disease
- 1Department of Neurology, Inselspital, University of Berne, Berne, Switzerland
- 2Department of Neurosurgery, University Hospital, Klinikum Mannheim, Mannheim, Germany
- Correspondence to: Prof Dr J K Krauss, Department of Neurosurgery, University Hospital, Klinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
- Received 21 January 2002
- Accepted 6 June 2002
- Revised 10 April 2002
Objective: To investigate the efficacy of chronic pallidal deep brain stimulation (DBS) on off period dystonia, cramps, and sensory symptoms in advanced Parkinson’s disease (PD).
Methods: 16 patients (6 women, 10 men; mean age at surgery 65 years) suffering from advanced PD were followed up prospectively for one year after implantation of a monopolar electrode in the posteroventral lateral globus pallidus internus. Unilateral DBS was performed in 9 patients. 10 patients had bilateral procedures (contemporaneous bilateral surgery in 7 and staged bilateral surgery in 3 instances). The decision whether to perform unilateral or bilateral surgery depended on the clinical presentation of the patient. Patients were formally assessed preoperatively, at 3–5 days, 3 months, and 12 months after surgery.
Results: In patients who underwent unilateral surgery, pain was present in 7 (78%), off dystonia in 5 (56%), cramps in 6 (67%), and dysaesthesia in 4 (44%). In patients who underwent bilateral surgery, pain was present in 7 (70%), off dystonia in 6 (60%), cramps in 7 (70%), and dysaesthesia in 4 (40%). With unilateral DBS, contralateral off period dystonia was improved by 100% at 1 year postoperatively, pain by 74%, cramps by 88%, and dysaesthesia by 100%. There was less pronounced amelioration of ipsilateral off period dystonia and sensory symptoms. With bilateral DBS, total scores for dystonia were improved by 86%, for pain by 90%, for cramps by 90%, and for dysaesthesia by 88%. The benefit appeared early at the first evaluation 3–5 days after surgery and was stable throughout the follow up period.
Conclusions: Pallidal DBS yields major improvement of off period dystonia, cramps, and sensory symptoms in patients with advanced PD.
- CT, computed tomography
- DBS, deep brain stimulation
- GPi, globus pallidus internus
- PD, Parkinson’s disease
- STN, subthalamic nucleus
- UPDRS, unified Parkinson’s disease rating scale
Competing interests: J K Krauss is a consultant to Medtronic, Inc