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

Gervais‐Bernard, Hélène; Xie‐Brustolin, Jing; Mertens, Patrick; Polo, Gustavo; Klinger, Hélène; Adamec, D.; Broussolle, Emmanuel; Thobois, Stéphane

doi:10.1007/s00415-009-0076-2

Cited by 146 publications

(130 citation statements)

References 56 publications

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“…Since the introduction of STN DBS in 1993, many clinical studies have shown that this therapy is safe and effective [2,3] during a 4- to 8-year follow-up [4,5,6,7,8,9]. However, from studies with a longer follow-up we learned that the motor benefit slowly wears off because of disease progression with axial and non-motor symptoms, which do respond sufficiently to dopaminergic medication and stimulation.…”

Section: Introductionmentioning

confidence: 99%

Subthalamic Nucleus High-Frequency Stimulation for Advanced Parkinson's Disease: Motor and Neuropsychological Outcome after 10 Years

Janssen

Duits²,

Tourai³

et al. 2014

Stereotact Funct Neurosurg

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Background: Since the introduction of subthalamic nucleus deep brain stimulation (STN DBS), many clinical studies have shown that this therapy is safe and effective in the short and medium term. Only little is known about long-term results. Objectives: To provide an analysis of motor and cognitive outcome 10 years after STN DBS. Methods: In this observational cohort study, we report on the motor and cognitive outcome in a cohort of 26 Parkinson's disease patients who were prospectively followed up for 10 years after STN DBS surgery. Results: In the early post-operative phase, improvement in the Unified Parkinson's Disease Rating Scale (UPDRS) III (10.6, p < 0.01) and IV (2.5, p < 0.01) was seen as well as a 32% reduction in levodopa equivalent dose (p < 0.01). After 5 years, a worsening of the motor performance was observed. The worsening of motor performance was mainly due to a deterioration in bradykinesia (12.4 ± 4.6, p < 0.05) and axial symptoms (6.9 ± 2.8, p < 0.01). Memory function seemed to improve in the short term, but there was a significant decline between 1 and 5 years after surgery (p < 0.01). Mood remained relatively stable during follow-up, and one third of the patients showed impulsive behaviour after surgery. Conclusions: The motor performance of patients showed deterioration over time, due to an increase in bradykinesia and axial symptoms.

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Section: Introductionmentioning

confidence: 99%

Subthalamic Nucleus High-Frequency Stimulation for Advanced Parkinson's Disease: Motor and Neuropsychological Outcome after 10 Years

Janssen

Duits²,

Tourai³

et al. 2014

Stereotact Funct Neurosurg

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“…10,28,29,33,35,65 However, a large multicenter study 91 found that the completed suicide rate following subthalamic DBS in PD is less than 0.5%, suggesting that suicide occurrences are unlikely to influence data significantly in this regard. We found that there are no long-term studies comparing the several therapeutic strategies for PD that adequately report objective data concerning anxiety and depression.…”

Section: Discussionmentioning

confidence: 99%

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

et al. 2014

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RESUMOIntrodução: A estimulação cerebral profunda (ECP) é eficaz na doença de Parkinson (DP) avançada, melhorando sintomas motores, flutuações e a qualidade de vida. No entanto, têm sido reportados efeitos adversos psiquiátricos, mas de uma forma variável e não padronizada. O objectivo deste artigo é analisar e sumarizar a evidência publicada sobre sintomas depressivos e ansiedade em doentes com DP após ECP, através de revisão sistemática e meta-análise. Material e Métodos: A PubMed foi pesquisada até Maio 2012 para identificar os estudos que avaliaram sintomas depressivos e ansiedade em doentes com doença de Parkinson submetidos a estimulação cerebral profunda bilateral do núcleo subtalâmico (NST) ou globo pálido interno (GPi). Foram feitas meta-análises com modelo de efeitos aleatórios para grupos de pelo menos três estudos homogéneos em relação ao desenho e instrumentos utilizados. Resultados: Foram selecionadas 63 referências; 98,4% continham dados relativos a escalas de avaliação de depressão e 38,1% relativos a ansiedade. Dois estudos não discriminavam o alvo usado; nos restantes 61 foi feita avaliação de curto prazo em 37 (60,7%), de médio prazo em 36 (59,0%) e de longo prazo em 5 (8,2%). Foram encontrados dados sobre variação pré/pós operatória em 57 (93,4%) estudos e 16 (26,2%) continham dados comparando ECP-NST versus outros grupos: ECP-GPi (n = 4 estudos, 25,0%), elegíveis para cirurgia (n = 6, 37,5%), e tratamento médico (n = 7, 43,8%). Discussão: É aparente a melhoria de depressão e ansiedade após ECP, sobretudo a curto prazo, efeito que tende a esbater-se em avaliações posteriores. Em relação à depressão a ECP-NST mostrou-se superior ao tratamento médico, mas não em comparação com o grupo de controlo elegível para cirurgia. Verificou-se o resultado oposto para a ansiedade, uma vez que os resultados favorecem o tratamento médico sobre a ECP-NST, e esta sobre o grupo de elegíveis para cirurgia. Não é evidente a superioridade de um alvo sobre o outro, mas os dados favorecem ligeiramente o GPi para ambos os tipos de sintomas. Conclusões:O padrão e curso dos sintomas depressivos e ansiedade após ECP na DP não são claros, mas ambos parecem melhorar no curto prazo, especialmente a depressão após a ECP-NST. Os resultados são bastante heterogéneos. Devem ser promovidos esforços no sentido de haver padronização de procedimentos de avaliação nos vários centros. Palavras-chave: Doença de Parkinson; Estimulação Cerebral Profunda; Ansiedade; Depressão; Meta-Análise. ABSTRACT Introduction: Deep brain stimulation (DBS) is effective in advancedParkinson's disease (PD), improving motor symptoms, fluctuations and quality of life. However, adverse psychiatric outcomes have been reported, albeit variably and in an unstandardized fashion. We aimed to summarize the published evidence on the outcomes of anxiety and depressive symptoms in Parkinson's disease patients following DBS, through systematic review and meta-analysis. Material and Methods: PubMed was searched until May 2012 to identify studies assessing anxiety and...

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“…Thirteen observational studies fulfilled the selection criteria. 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.…”

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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: Five year follow-up

Abstract: Our data confirm that bilateral STN stimulation is beneficial in the long-term for PD patients but does not prevent disease progression and the occurence of axial levodopa unresponsive signs in some patients.

Cited by 146 publications

References 56 publications

Subthalamic Nucleus High-Frequency Stimulation for Advanced Parkinson's Disease: Motor and Neuropsychological Outcome after 10 Years

Subthalamic Nucleus High-Frequency Stimulation for Advanced Parkinson's Disease: Motor and Neuropsychological Outcome after 10 Years

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

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

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