Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease
Elena Moro (1), Andrés M. Lozano (2), Pierre Pollak (3), Yves Agid (4), Stig Rehncrona (5), Jens Volkmann (6), Jaime Kulisevsky (7), Jose A. Obeso (8), Alberto Albanese (9, 10), Marwan I. Hariz (11 12), Niall P. Quinn (11), Jans D. Speelman (13), Alim L. Benabid (3), Valerie Fraix (3), Alexandre Mendes (3), Marie-Laure Welter (4), Jean-Luc Houeto (4, 14), Philippe Cornu (4), Didier Dormont (4), Annalena L. Tornqvist (5), Ron Ekberg (5), Alfons Schnitzler (15), Lars Timmermann (15, 16), Lars Wojtecki (15), Andres Gironell (7), María C. Rodríguez-Oroz (8), Jorge Guridi (8), Anna R. Bentivoglio (10), María F. Contarino (10, 13), Luigi Romito (9), Massimo Scerrati (10, 17), Marc Janssens (18), Anthony E. Lang (1)
(1) Toronto Western Hospital, Movement Disorders Center, University of Toronto and University Health Network, Toronto, Ontario, Canada
(2) Division of Neurosurgery, University of Toronto and University Health Network, Toronto, Ontario, Canada
(3) Service de Neurologie, CHU de Grenoble, Grenoble, France
(4) Hôpital de la Salpêtrière, Fédération de Neurologie, Paris, France
(5) Neurosurgery Service, Lund University Hospital, Lund, Sweden
(6) Neurologische Klinik der Christian-Albrect-Universitat, Kiel, Germany
(7) Department of Neurology, Sant Pau Hospital, Autonomous University of Barcelona, CIBERNED, Barcelona, Spain
(8) Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra, CIBERNED, Pamplona, Spain
(9) Istituto Nazionale Neurologico C. Besta and Università Cattolica, Milano, Italy
(10) Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Roma, Italy
(11) Institute of Neurology, Queen Square, London, UK
(12) Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden
(13) Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
(14) Service de Neurologie, CHU de Poitiers, University of Poitiers, Poitiers, France
(15) Department of Neurology and Institute of Clinical Neurosciences, Heinrich-Heine-Universitat Duesseldorf, Duesseldorf, Germany
(16) Department of Neurology, University Hospital, Cologne, Germany
(17) Dipartimento di Neuroscienze, Sezione di Neurochirurgia, Università Politecnica delle Marche, Ancona, Italy
(18) Bakken Research Center, Maastricht, The Netherlands
We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-five STN patients and 16 GPi patients were assessed at 5 to 6 years after DBS surgery.
Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN, P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with off-stimulation, regardless of the sequence of stimulation. In open assessment, both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN, P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group.
These results confirm the long-term efficacy of STN and GPi DBS in advanced PD. Although the surgical targets were not randomized, there was a trend to a better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group.
CITATION Mov Disord. 2010 Apr 15;25(5):578-86