Antiparkinsonian therapy modifications in PD patients after STN DBS: A retrospective observational analysis

Zibetti, Maurizio; Pesare, M.; Cinquepalmi, A.; Rosso, Michela; Bergamasco, B.; Ducati, Alessandro; Lanotte, Michele; Lopiano, Leonardo

doi:10.1016/j.parkreldis.2007.12.009

Cited by 17 publications

(12 citation statements)

References 18 publications

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“…Reductions in LEDD and medication costs following STN DBS have been shown in other studies with smaller samples and uncontrolled studies. 9,13,[15][16] The greater LEDD reduction for STN compared with GPi in the current study was accounted for primarily by less use of COMT inhibitors. Costs decreased immediately after STN DBS but did not decrease for GPi patients until after the first 6 months.…”

Section: Discussionmentioning

confidence: 64%

Parkinson's disease medication use and costs following deep brain stimulation

et al. 2012

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The costs of treating Parkinson's disease (PD) are significant. Medication reductions usually occur following deep brain stimulation (DBS), but less is known about the relative costs of DBS targets, the globus pallidum (GPi) or the subthalamic nucleus (STN). This article reports medication costs between best medical therapy (BMT) and DBS over 6 months postintervention and by DBS target over 36 months postsurgery. Prescription use and costs for patients (n = 161) with advanced PD from a multisite randomized trial of BMT and DBS were examined overall and by drug category. Medication adjustment occurred at the discretion of the neurologists. PD medications were extracted from the Department of Veterans Affairs Decision Support System database. Levodopa equivalents (LEDD) were significantly lower for DBS than for BMT patients at 6 months (1101 vs 1398 mg; P = .005), but costs were similar (US$1750 vs US$1589; P = .55). LEDD decreased following GPi and STN DBS (1395-1161 mg, P = .014; and 1347-891 mg, P < .0001, respectively) in the first 6 months, but was lower for STN than for GPi over 36 months following DBS (P = .03). Total PD medication costs per 6-month intervals decreased over 36 months (P < .0001), but did not differ by target (P = .50) in the mixed-model analysis. However, cumulative medication costs over 36 months were lower for the STN than for GPi patients. PD medication use and costs decreased following DBS in either target over 36 months, but cumulative costs were less for STN than for GPi.

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Section: Discussionmentioning

confidence: 64%

Parkinson's disease medication use and costs following deep brain stimulation

et al. 2012

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“…The results of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) are well-studied2,3,7-9,11,16-18,23,25,27,28,34,36,37). The benefits of STN DBS are not in doubt, and are supported even by long-term follow-up data.…”

Section: Introductionmentioning

confidence: 99%

Factors Related to Outcomes of Subthalamic Deep Brain Stimulation in Parkinson's Disease

Kim

Chang

Kang

et al. 2013

J Korean Neurosurg Soc

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ObjectiveSubthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment of choice for patients with advanced idiopathic Parkinson's disease (PD) who have motor complication with medication. The objectives of this study are to analyze long-term follow-up data of STN DBS cases and to identify the factors related to outcomes.MethodsFifty-two PD patients who underwent STN DBS were followed-up for more than 3 years. The Unified Parkinsons Disease Rating Scale (UPDRS) and other clinical profiles were assessed preoperatively and during follow-up. A linear regression model was used to analyze whether factors predict the results of STN DBS. We divided the study individuals into subgroups according to several factors and compared subgroups.ResultsPreoperative activity of daily living (ADL) and the magnitude of preoperative levodopa response were shown to predict the improvement in UPDRS part II without medication, and preoperative ADL and levodopa equivalent dose (LED) were shown to predict the improvement in UPDRS part II with medication. In UPDRS part III with medication, the magnitude of preoperative levodopa response was a predicting factor.ConclusionThe intensity of preoperative levodopa response was a strong factor for motor outcome. And preoperative ADL and LED were strong factors for ADL improvement. More vigorous studies should be conducted to elucidate how levodopa-induced motor complications are ameliorated after STN DBS.

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“…There are several papers reporting 3-4 year post-operative follow-ups of the implant of this target [16,23,25,28,33,38], while there is still a paucity of data at longer term; in this study we aimed to give an overview of the most remarkable papers covering the clinical outcome, the dopaminergic therapy modification and the complications 5 years or more after STN-DBS procedures.…”

Section: Introductionmentioning

confidence: 99%

Dopaminergic therapy and subthalamic stimulation in Parkinson’s disease: a review of 5-year reports

Romito

Albanese

2010

J Neurol

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The long-term efficacy and safety of deep brain stimulation (DBS) implant for Parkinson's disease (PD) is described in several recent papers. This procedure has been reported to permit a stable reduction of dopaminergic therapy requirements for up to 5 years, although some expectation of deterioration in non-dopaminergic signs has been recently stated. Our aim is to perform a literature-based review of papers available describing long-term post-operative follow-up after a bilateral implant for subthalamic DBS (STN-DBS). Only peer-reviewed published papers with a post-operative follow-up of at least 5 years were considered. Clinical outcome, disease progression and side effects were assessed at baseline and 2 (or 3 years) and 5 years after surgery. Seven papers were included in the review. A total of 238 patients were analyzed. STN-DBS was confirmed to be an effective treatment for selected patients with PD. In all studies, off-related motor symptoms improved dramatically, compared with pre-implant, at 2 (or 3, according to the study) years and this result persisted at 5-year evaluations. Antiparkinsonian drug reductions, improvements in motor fluctuations and dyskinesias, functional measures and the progression of underlying PD were also reported in all series. Some axial scores, in particular postural stability and speech, improved transiently. Persisting adverse effects included eyelid opening apraxia, weight gain, psychiatric disorders, depression, dysarthria, dyskinesias, and apathy. The present review of the 5-year observations confirms that STN-DBS is a powerful method in the management of PD, but its long-term effects must be thoroughly assessed.

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Antiparkinsonian therapy modifications in PD patients after STN DBS: A retrospective observational analysis

Cited by 17 publications

References 18 publications

Parkinson's disease medication use and costs following deep brain stimulation

Parkinson's disease medication use and costs following deep brain stimulation

Factors Related to Outcomes of Subthalamic Deep Brain Stimulation in Parkinson's Disease

Dopaminergic therapy and subthalamic stimulation in Parkinson’s disease: a review of 5-year reports

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