Efficacy of deep brain stimulation of the subthalamic nucleus in Parkinson's disease 4 years after surgery: double blind and open label evaluation

被引:127
作者
Rodriguez-Oroz, MC
Zamarbide, I
Guridi, J
Palmero, MR
Obeso, JA [1 ]
机构
[1] Univ Navarra, Clin Univ & Med Sch, Dept Neurol & Neurosurg, Ctr Neurosci, Pamplona 31008, Spain
[2] Hosp, Serv Neurol & Neurosurg, Tenerife, Spain
关键词
D O I
10.1136/jnnp.2003.031294
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To evaluate the long term (4 years) efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in advanced Parkinson's disease. Methods: We performed a double blind crossover evaluation of the efficacy of DBS of the STN in the "off'' medication condition in 10 patients with Parkinson's disease. Assessments included the Unified Parkinson's Disease Rating Scale (UPDRS) part III (motor) and two timed tests (arm tapping and walking). Open evaluation of the effect of stimulation in the off and on drug states preoperatively and at 1 and 4 years postoperatively was also conducted. The latter assessment included the UPDRS parts II (activities of daily living) and III (dyskinesia scale and global assessment) as judged by the patient and examiner. The mean amount of levodopa daily dose at base line, 1 year, and 4 years after surgery was compared. Results: A significant (p<0.04) effect of stimulation was observed in the overall group regarding both the UPDRS motor and the timed tests. Open evaluation also showed a significant benefit of STN DBS with respect to preoperative assessment in both the motor and activities of daily living scales, dyskinesia scale, and in global assessment. Levodopa daily dose was reduced by 48% and 50% at 1 and 4 years, respectively. There was no difference between the 1 and 4 years evaluations in any of the parameters evaluated. Complications due to stimulation were minor. Conclusions: DBS of the STN provides a significant and persistent anti-parkinsonian effect in advanced Parkinson's disease 4 years after surgery.
引用
收藏
页码:1382 / 1385
页数:4
相关论文
共 24 条
[1]   Predictors of effective bilateral subthalamic nucleus stimulation for PD [J].
Charles, PD ;
Van Blercom, N ;
Krack, P ;
Lee, SL ;
Xie, J ;
Besson, G ;
Benabid, AL ;
Pollak, P .
NEUROLOGY, 2002, 59 (06) :932-934
[2]   Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson's disease with severe motor fluctuations: a 2-year follow-up review [J].
Ghika, J ;
Villemure, JG ;
Fankhauser, H ;
Favre, J ;
Assal, G ;
Ghika-Schmid, F .
JOURNAL OF NEUROSURGERY, 1998, 89 (05) :713-718
[3]  
Guridi J, 2000, NEUROLOGY, V55, pS21
[4]  
Houeto JL, 2002, J NEUROL NEUROSUR PS, V72, P701, DOI 10.1136/jnnp.72.6.701
[5]   Double blinded evaluation of the effects of pallidal and subthalamic nucleus stimulation on daytime activity in advanced Parkinson's disease [J].
Katayama, Y ;
Kasai, M ;
Oshima, H ;
Fukaya, C ;
Yamamoto, T ;
Mizutani, T .
PARKINSONISM & RELATED DISORDERS, 2000, 7 (01) :35-40
[6]   Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease [J].
Kleiner-Fisman, G ;
Fisman, DN ;
Sime, E ;
Saint-Cyr, JA ;
Lozano, AM ;
Lang, AE .
JOURNAL OF NEUROSURGERY, 2003, 99 (03) :489-495
[7]   Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease [J].
Krack, P ;
Batir, A ;
Van Blercom, N ;
Chabardes, S ;
Fraix, V ;
Ardouin, C ;
Koudsie, A ;
Limousin, PD ;
Benazzouz, A ;
LeBas, JF ;
Benabid, AL ;
Pollak, P .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (20) :1925-1934
[8]   A novel quality of life instrument for deep brain stimulation in movement disorders [J].
Kuehler, A ;
Henrich, G ;
Schroeder, U ;
Conrad, B ;
Herschbach, P ;
Ceballos-Baumann, A .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2003, 74 (08) :1023-1030
[9]   Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease [J].
Kumar, R ;
Lozano, AM ;
Kim, YJ ;
Hutchison, WD ;
Sime, E ;
Halket, E ;
Lang, AE .
NEUROLOGY, 1998, 51 (03) :850-855
[10]   Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD [J].
Lagrange, E ;
Krack, P ;
Moro, E ;
Ardouin, C ;
Van Blercom, N ;
Chabardes, S ;
Benabid, AL ;
Pollak, P .
NEUROLOGY, 2002, 59 (12) :1976-1978