TY - JOUR
T1 - Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: long-term observation
AU - Romito,
AU - Contarino, Maria Fiorella
AU - Vanacore, N
AU - Bentivoglio, Anna Rita
AU - Scerrati, M
AU - Albanese, Alberto
PY - 2009
Y1 - 2009
N2 - Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long-term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on-period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long-term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures.
AB - Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long-term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on-period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long-term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures.
KW - Deep Brain Stimulation
KW - Disability Evaluation
KW - Dopamine Agents
KW - Electrodes, Implanted
KW - Levodopa
KW - Longitudinal Studies
KW - Motor Activity
KW - Parkinson Disease
KW - Severity of Illness Index
KW - Subthalamic Nucleus
KW - Time Factors
KW - Treatment Outcome
KW - Deep Brain Stimulation
KW - Disability Evaluation
KW - Dopamine Agents
KW - Electrodes, Implanted
KW - Levodopa
KW - Longitudinal Studies
KW - Motor Activity
KW - Parkinson Disease
KW - Severity of Illness Index
KW - Subthalamic Nucleus
KW - Time Factors
KW - Treatment Outcome
UR - http://hdl.handle.net/10807/28002
U2 - 10.1002/mds.22390
DO - 10.1002/mds.22390
M3 - Article
SN - 0885-3185
VL - 24
SP - 557
EP - 563
JO - Movement Disorders
JF - Movement Disorders
ER -