Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson’s disease
- V Fraix1,
- J-L Houeto2,
- C Lagrange1,
- C Le Pen3,
- P Krystkowiak4,
- D Guehl5,
- C Ardouin1,
- M-L Welter2,
- F Maurel3,
- L Defebvre4,
- A Rougier5,
- A-L Benabid1,
- V Mesnage2,
- M Ligier3,
- S Blond4,
- P Burbaud5,
- B Bioulac5,
- A Destée4,
- P Cornu2,
- P Pollak1,
- on behalf of the SPARK Study Group
- 1Department of Neurology and Neurosurgery, Grenoble University Hospital and INSERM U318, Joseph Fourier University, Grenoble, France
- 2Federation of Neurology, Clinical Investigation Centre, La Pitié-Salpétrière Hospital, Paris, France
- 3CLP-Santé, Paris, France
- 4Department of Neurology and Neurosurgery, Lille University Hospital, Lille, France
- 5Department of Neurology and Neurosurgery, Bordeaux University Hospital, Bordeaux, France
- Correspondence to: Pierre Pollak Department of Neurology, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 9, France;
- Received 3 August 2005
- Accepted 15 November 2005
- Revised 5 October 2005
Background: High frequency stimulation of the subthalamic nucleus (STN) is an alternative but expensive neurosurgical treatment for parkinsonian patients with levodopa induced motor complications.
Objective: To assess the safety, clinical effects, quality of life, and economic cost of STN stimulation.
Methods: We conducted a prospective multicentre study in 95 consecutive Parkinson’s disease (PD) patients receiving bilateral STN stimulation and assessed its effects over 12 months. A double blind randomised motor evaluation was carried out at 3 month follow up, and quality of life, self care ability, and predictive factors of outcome following surgery were assessed. The cost of PD was estimated over 6 months before and after surgery.
Results: The Unified Parkinson’s Disease Rating Scale (UPDRS) motor score improved by 57% (p<0.0001) and activities of daily living improved by 48% (p<0.0001) at 12 month follow up. Double blind motor scoring improved by 51% at 3 month follow up (p<0.0001). The total PD Quality of Life Questionnaire (PDQL-37) score improved by 28% (p<0.001). The better the preoperative motor score after a levodopa challenge, the better the outcome after STN stimulation. Five patients developed an intracerebral haematoma during electrode implantation with permanent after effects in two. The 6 month costs of PD decreased from €10 087 before surgery to €1673 after surgery (p<0.0001) mainly because of the decrease in medication. These savings allowed a return on the procedure investment, estimated at €36 904 over 2.2 years.
Conclusions: STN stimulation has good outcomes with relatively low risk and little cost burden in PD patients with levodopa induced motor complications.
- PD, Parkinson’s disease
- PDQL-37, Parkinson’s Disease Quality of Life Questionnaire
- STN, subthalamic nucleus
- UPDRS, Unified Parkinson’s Disease Rating Scale
Members of the SPARK Study Group: neurologists: Grenoble, France: Valérie Fraix, Elena Moro, Pierre Pollak, Nadège Van Blercom, Jing Xie; Paris, France: Yves Agid, Anne-Marie Bonnet, Philippe Damier, Jean-Luc Houeto, Valérie Mesnage, Marie Vidailhet, Marie-Laure Welter; Lille, France: Luc Defebvre, Alain Destée, Pierre Krystkowiak, Nawal Waucquier; Bordeaux, France: Bernard Bioulac, Pierre Burbaud, Dominique Guehl, Alain Lagueny, François Tison; neurosurgeons: Grenoble, France: Alim-Louis Benabid, Stephan Chabardes, Adnan Koudsie; Paris, France: Philippe Cornu, Soledad Navarro; Lille, France: Serge Blond, Gustavo Touzet; Bordeaux, France: Emmanuel Cuny, Alain Rougier; intraoperative neurophysiology: Grenoble, France: Abdelhamid Benazzouz; Paris, France: Bernard Pidoux; Lille, France: François Cassim; Bordeaux, France: Christian Gross; magnetic resonance imaging: Grenoble, France: Sylvie Grand, Jean-François Le Bas; Paris, France: Didier Dormont; Lille, France: Jean-Pierre Pruvo, Christine Delmaire; Bordeaux, France: Vincent Dousset; neuropsychological evaluation: Grenoble, France: Claire Ardouin, Hélène Klinger; Paris, France: Bernard Pillon; Lille, France: Kathy Dujardin; Bordeaux, France: Sandra Machado; biostatistics: INRIA, Grenoble, France: Gilles Celeux, Christian Lavergne, Virginie Roy; economic study: CLP-Santé, Paris, France: Claude Le Pen, Marie Ligier, Frédérique Maurel; Clinical Investigation Centre, Paris, France: Laurence Vigil; study supervision: Grenoble, France: Christelle Lagrange.
This work was supported by the Fondation pour la Recherche Médicale (FRM, Paris, France) (financial support, Action Santé 2000), INSERM U318 (Grenoble, France), the Clinical Investigation Centre (CIC, Paris, France), and the University Hospital of Grenoble, France.
Competing interests: none declared. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or in the writing of the paper.