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Bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease: Five year follow-up

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Abstract

Objective

To assess the long-term efficacy and safety of bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson’s disease (PD).

Methods

42 consecutive patients with idiopathic PD treated with bilateral STN stimulation were enrolled. Parkinsonian status, medication intake and neuropsychological evaluation were assessed preoperatively and at 1 and 5 years postoperatively in on and off medication/on and off stimulation conditions.

Results

23 patients could be followed-up 5 years after surgery. In the remaining cases, 5 died, 1 could not be assessed because of device removal for infection, 1 decided not to be stimulated, and 11 were lost of follow-up (one because of a liver carcinoma and the others because they refused the formal four conditions of assessment). STN stimulation reduced the UPDRS motor score by 55 % compared to baseline in the offmedication conditions. Tremor, rigidity, bradykinesia, postural stability, and gait improved by 74 %, 66 %, 59 %, 17 % and 37 %, respectively. UPDRS part II scores were reduced by 38 %. The dopaminergic treatment daily dose was reduced by 54.4 % after surgery. Axial dopa-unresponsive signs worsened in some patients. Among the 42 initial patients we observed the following: 2 brain hemorrhages, 3 infections of the device, 2 phlebitis and 1 pulmonary embolism. In addition, 2 patients needed a repositioning of the electrode. Among the 23 patients followed at 5 years, long lasting side effects consisted in dysarthria (56 %), depression (39 %), eyelid opening apraxia (30.4 %) and apathy (4.3 %).

Conclusions

Our data confirm that bilateral STN stimulation is beneficial in the long-term for PD patients but does not prevent disease progression and the occurence of axial levodopa unresponsive signs in some patients.

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Authors and Affiliations

  1. Service de Neurologie C, Hôpital Neurologique Pierre Wertheimer, 59 Bd Pinel, 69677, Bron Cedex, France

    S. Thobois MD, PhD

  2. Claude Bernard Lyon I, Université de Lyon, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France

    H. Gervais-Bernard MD, J. Xie-Brustolin MD, PhD, H. Klinger MA, D. Adamec MD, E. Broussolle MD, PhD &  S. Thobois MD, PhD

  3. Claude Bernard Lyon I, Université de Lyon, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurochirurgie A (Pr M. Sindou), Lyon, France

    P. Mertens MD, PhD & G. Polo MD

  4. INSERM U864, Bron, France

    E. Broussolle MD, PhD &  S. Thobois MD, PhD

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  1. H. Gervais-Bernard MD
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  2. J. Xie-Brustolin MD, PhD
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  3. P. Mertens MD, PhD
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  4. G. Polo MD
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  5. H. Klinger MA
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  7. E. Broussolle MD, PhD
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  8. S. Thobois MD, PhD
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Correspondence to S. Thobois MD, PhD.

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Gervais-Bernard, H., Xie-Brustolin, J., Mertens, P. et al. Bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease: Five year follow-up. J Neurol 256, 225–233 (2009). https://doi.org/10.1007/s00415-009-0076-2

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  • DOI: https://doi.org/10.1007/s00415-009-0076-2

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