Long‐term outcomes of surgical therapies for Parkinson's disease

Abstract

The surgical lesion of different brain structures has been used as a treatment for Parkinson's disease (PD) for several decades. More recently, the favored therapeutic approach has involved the administration of levodopa and the use of DBS. These two major therapeutic advances have greatly modified both the clinical condition of patients and the history of the disease. With the introduction of L‐dopa in 1967, patients could regain mobility, because their akinesia, tremor, and rigidity were greatly improved, with consequent significant improvement in quality of life and increased life expectancy. However, after the so‐called “honeymoon” period in which the disease seemed to be controlled, motor fluctuations and L‐dopa‐induced dyskinesias mitigated the initial enthusiasm. In the 1990s, unilateral pallidotomy and DBS of the globus palllidus internus and STN reduced these motor fluctuations and dyskinesias remarkably, thereby inaugurating a new era in the surgical treatment of PD. Short‐ and medium‐term follow‐up studies of patients who underwent surgery have documented sustained, significant motor benefits. However, given the progressive nature of PD and the purely symptomatic effects of pallidotomy and DBS, the long‐term clinical evolution of these surgical patients currently seems to be associated with a new PD phenotype, mainly characterized by axial motor problems and cognitive impairment. Here, we analyze the long‐term clinical outcomes of surgical PD patients with at least 5‐year follow‐up, focusing on the long‐term motor symptoms that were initially responsive to surgery. © 2012 Movement Disorder Society

Does probe’s eye subthalamic nucleus length on t2w MRI correspond with microelectrode recording in patients with deep brain stimulation for advanced parkinson’s disease ?

“…The clinical improvement found in this study is in line with previous publications (3,7,10,12). In our study population we observed one case of transient hemiballismus and one case of transient hypomania after STN DBS.…”

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

“…117 Surgical treatment of Parkinson's disease has given rise to a new phenotype of patients with advanced Parkinson's disease who have little akinesia, no tremor or rigidity, and little dyskinesia, and are mainly disabled by frontal dementia, apathy, and levodoparesistant axial motor features. 118 Diff erent mechanisms might therefore underlie early and potentially reversible postoperative apathy and more tardive non-reversible apathy. Whereas the early and potentially reversible form of apathy occurs in the context of withdrawal of dopaminergic drugs, the tardive non-reversible form seems more related to cognitive deterioration and progression of synucleino pathy, which is transmitted by projection neurons to their target Review neurons.…”

Subthalamic stimulation or subthalamic lesion for Parkinson's disease ? A case report

“…The benefits of subthalamotomy have been reported to persist for a follow-up of 3e6 years [2]. Some loss of benefit over time however has been noted in a subpopulation [2] whereas the benefit was maintained up to 24 months in some patients [4] while long-term STN stimulation efficacy with stable effect on tremor and rigidity has been reported with a follow-up of 5e10 years [1]. STN stimulation is a reversible and adaptable treatment and the stimulation of each STN can be separately adjusted over time, which is not possible with subthalamotomy.…”

“…STN stimulation is a reversible and adaptable treatment and the stimulation of each STN can be separately adjusted over time, which is not possible with subthalamotomy. However, despite long-term efficacy of surgical therapies for PD, there is a progressive worsening of the disease inevitably leading to disability in the very long term related to disease progression (worsening of akinesia, postural instability, dysarthria and swallowing difficulties, cognitive deterioration) following both STN stimulation and STN lesion [1].…”

“…Efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) is well recognized [1]. Subthalamotomy has also shown to be effective in treatment of PD [1e4].…”