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Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up
  1. W M M Schüpbach1,
  2. N Chastan1,
  3. M L Welter1,
  4. J L Houeto1,
  5. V Mesnage1,
  6. A M Bonnet1,
  7. V Czernecki1,
  8. D Maltête1,
  9. A Hartmann1,
  10. L Mallet1,
  11. B Pidoux2,
  12. D Dormont3,
  13. S Navarro4,
  14. P Cornu4,
  15. A Mallet5,
  16. Y Agid1
  1. 1Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  2. 2Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  3. 3Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  4. 4Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  5. 5Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris, France
  1. Correspondence to:
 Dr Y Agid
 Centre d’Investigation Clinique, Hôpital de la Salpêtrière, 47 boulevard de l’Hôpital, 75013 Paris, France; yves.agidpsl.ap-hop-paris.fr

Abstract

Background: The short term benefits of bilateral stimulation of the subthalamic nucleus (STN) in patients with advanced levodopa responsive Parkinson’s disease (PD) are well documented, but long term benefits are still uncertain.

Objectives: This study provides a 5 year follow up of PD patients treated with stimulation of the STN.

Methods: Thirty seven consecutive patients with PD treated with bilateral STN stimulation were assessed prospectively 6, 24, and 60 months after neurosurgery. Parkinsonian motor disability was evaluated with and without levodopa treatment, with and without bilateral STN stimulation. Neuropsychological and mood assessments included the Mattis Dementia Rating Scale, the frontal score, and the Montgomery-Asberg Depression Rating Scale (MADRS).

Results: No severe peri- or immediate postoperative side effects were observed. Six patients died and one was lost to follow up. Five years after neurosurgery: (i) activity of daily living (Unified Parkinson Disease Rating Scale (UPDRS) II) was improved by stimulation of the STN by 40% (“off” drug) and 60% (“on” drug); (ii) parkinsonian motor disability (UPDRS III) was improved by 54% (“off” drug) and 73% (“on” drug); (iii) the severity of levodopa related motor complications was decreased by 67% and the levodopa daily doses were reduced by 58%. The MADRS was unchanged, but cognitive performance declined significantly. Persisting adverse effects included eyelid opening apraxia, weight gain, addiction to levodopa treatment, hypomania and disinhibition, depression, dysarthria, dyskinesias, and apathy.

Conclusions: Despite moderate motor and cognitive decline, probably due to disease progression, the marked improvement in motor function observed postoperatively was sustained 5 years after neurosurgery.

  • ADL, activities of daily living
  • IQR, interquartile range
  • MADRS, Montgomery-Asberg Depression Rating Scale
  • PD, Parkinson’s disease
  • SD, standard deviations
  • STN, subthalamic nucleus
  • UPDRS, Unified Parkinson Disease Rating Scale
  • Parkinson’s disease
  • stimulation
  • subthalamic nucleus

https://doi.org/10.1136/jnnp.2005.063206

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    Footnotes

    • The study was supported by INSERM and the National Parkinson Foundation-Miami. Dr Schüpbach was supported by grants from the Swiss National Science Foundation and the Swiss Parkinson’s Disease Association

    • Competing interests: none declared