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

Abstract

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.

A Common Optimization Principle for Motor Execution in Healthy Subjects and Parkinsonian Patients

“…Like work, the mean agonist command was significantly modulated by movement extent (Fig. 6C), as already observed experimentally in control subjects and PD patients (Berardelli et al, 1986;Pfann et al, 2001;Robichaud et al, 2002). This increase, mostly due to a lengthening of the agonist command for the longest movements, highlights the difference between global (mean) and peak motor activation.…”

Langzeiteffekte der tiefen Hirnstimulation bei Bewegungsstörungen

“…Neben zwei früheren Übersichten zu Langzeiteffekten der THS bei Parkinson haben unter anderen Deuschl und Agid einen umfassenden Überblick zum Thema vorgelegt [3,21,22]. Die durchschnittliche kurzfristige Reduktion der UPDRS-III-Werte nach THS im STN betrug nach einer Literaturübersicht 52% [11].…”

“…Insbesondere die Skalenwerte der Aktivitäten des täglichen Lebens verschlechterten sich nach einem Zeitraum von 5 Jahren oder mehr [3,22]. So wurde in einer Studie nach 8 Jahren eine deutliche Verschlechterung der Aktivitäten des täg-lichen Lebens gegenüber der Baseline beobachtet, während nach 5 Jahren die Bilanz noch positiv gewesen war [7].…”

“…Neben Gangstö-rungen/Stürzen, (meist reversiblen) Parästhesien und Dysarthrie können nach THS selten auch epileptische Anfälle beobachtet werden. Ferner kann bei über 10% eine Lidöffnungsapraxie auftreten [22]. Als technische Probleme treten mit sehr unterschiedlicher Inzidenz Kabelbrüche, Elektrodendislokationen oder Infektionen auf.…”

A manic episode after bilateral subthalamic stimulation in a patient with advanced Parkinson's disease

“…lead breaking, stimulator malfunction) and stimulation-related (e.g. dyskinesia, blepharospasm and speech disturbances) problems (4,5). Furthermore, a number of different psychiatric and cognitive problems have been reported with DBS: depression (8%), transient hypomania (8%), manic episodes (4%) and, to a lesser extent, anxiety disorders, personality changes, apathy and aggressive behaviours (3,5).…”