Bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease

Gan, Jing; Xie‐Brustolin, Jing; Mertens, Patrick; Polo, Gustavo; Klinger, Hélène; Mollion, Hélène; Bénatru, Isabelle; Henry, E. P.; Broussolle, Emmanuel; Thobois, Stéphane

doi:10.1007/s00415-006-0297-6

Cited by 35 publications

(29 citation statements)

References 39 publications

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“…Among these studies only three reported 5-year follow-up of PD patients operated with bilateral STN stimulation [26,41,52]. Following our previous published experience [18,45], we report the results obtained 5 years postoperatively in a cohort of 42 consecutive patients with advanced PD who underwent chronic bilateral STN stimulation.…”

Section: Introductionmentioning

confidence: 97%

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

et al. 2009

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Section: Introductionmentioning

confidence: 97%

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

et al. 2009

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“…In patients insufficiently responding to, or experiencing unacceptable side effects from medical treatment, substantial and long-lasting benefits following DBS have been demonstrated, including improved motor function, reduced dyskinesia, decreased medication usage, and increased quality of life [4,5,8,11,13,16,18,19]. Patient eligibility for DBS is determined in specialised movement disorders centres using a comprehensive selection process, including a levodopa challenge test, brain imaging and assessment of neuropsychological and psychiatric functions.…”

Section: Introductionmentioning

confidence: 99%

A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

Moro

Allert

Eleopra³

et al. 2009

J Neurol

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“…Two of these studies were excluded 16,17 because the population samples were subsets of the populations in 2 other articles that were included because they had larger sample sizes. 18,19 Of the remaining 11 studies, 3 examined bilateral GPi, 9 examined bilateral STN stimulation, and 1 study included both STN and GPi target sites. 19 In the Lyons et al 20 study, 3 of the 9 subjects had unilateral GPi stimulation but the results lumped the unilateral and bilateral cases.…”

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confidence: 99%

A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD

George¹,

Nutt²,

Burchiel³

et al. 2010

Neurology

273

192

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Objective: Deep brain stimulation (DBS) alleviates the cardinal Parkinson disease (PD) symptoms of tremor, rigidity, and bradykinesia. However, its effects on postural instability and gait disability (PIGD) are uncertain. Contradictory findings may be due to differences the in stimulation site and the length of time since DBS surgery. This prompted us to conduct the first meta-regression of long-term studies of bilateral DBS in the subthalamic nucleus (STN) and globus pallidus interna (GPi).Results: Eleven articles reported a breakdown of the Unified Parkinson's Disease Rating Scale score before and beyond 3 years postsurgery (mean 4.5 years). Random effects meta-regression revealed that DBS initially improved PIGD compared to the OFF medicated state before surgery, but performance declined over time and extrapolation showed subjects would reach presurgery levels 9 years postsurgery. ON medication, DBS improved PIGD over and above the effect of medication before surgery. Nevertheless, for the STN group, PIGD progressively declined and was worse than presurgery function within 2 years. In contrast, GPi patients showed no significant long-term decline in PIGD in the medicated state. Improvements in cardinal signs with DBS at both sites were maintained across 5 years in the OFF and ON medication states.Conclusions: DBS alone does not offer the same improvement to PIGD as it does to the cardinal symptoms, suggesting axial and distal control are differentially affected by DBS. GPi DBS in combination with levodopa seemed to preserve PIGD better than did STN DBS, although more studies of GPi DBS and randomized controls are needed. Neurology Balance and gait are gradually, and inevitably, impaired as Parkinson disease (PD) progresses, resulting in significant impairment of mobility. Mobility disability is one of the most important causes of diminished quality of life, morbidity, and mortality in patients with PD.1,2 Deep brain stimulation (DBS) of either the subthalamic nucleus (STN) or globus pallidus interna (GPi) is an increasingly common therapy for mid-to late-stage PD. With optimized stimulation settings, DBS typically lessens the motor symptoms of tremor, limb rigidity, bradykinesia, and akinesia. However, the long-term effects on balance, locomotion, and speech, often referred to as axial motor signs, are debated.Despite improvements in clinical ratings of PIGD immediately after DBS surgery, patients tend to fall more.3 These seemingly contradictory findings are not altogether surprising given that balance and gait are complex behaviors consisting of many sensorimotor subsystems that may not be fully characterized by the PIGD items in the Unified Parkinson's Disease Rating Scale (UPDRS). So although posture and gait are affected by bradykinesia, rigidity, and to a lesser extent tremor, other sensorimotor systems underlying posture and gait, such as setdependent flexibility, 4 sensory integration, 5 and postural synergies, 6 do not show the same responsiveness to levodopa. Therefore, each subsystem underl...

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Bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease

Cited by 35 publications

References 39 publications

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

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

A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD

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