Side‐effects of subthalamic stimulation in Parkinson's disease: clinical evolution and predictive factors

Guehl, Dominique; Cuny, Emmanuel; Benazzouz, Abdelhamid; Rougier, Alain; Tison, François; Machado, Sandra; Grabot, Denis; Gross, Christian E.; Bioulac, Bernard; Burbaud, Pierre

doi:10.1111/j.1468-1331.2006.01405.x

Cited by 73 publications

(37 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the literature, pre-operative predictive factors for STN-DBS outcome include young age and high baseline values or levodopa responsiveness of UPDRS III scores, in particular regarding the axial subscore [8,9,10,11,12,13,14]. Herein, patients have been selected to the bilateral STN stimulation procedure according to a specific set of clinical characteristics.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcome of Bilateral Subthalamic Nucleus Stimulation in the Treatment of Parkinson’s Disease: Correlation with Intra-Operative Multi-Unit Recordings but Not with the Type of Anaesthesia

Lefaucheur

Gurruchaga²,

Pollin³

et al. 2008

Eur Neurol

View full text Add to dashboard Cite

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) gained general acceptance in the treatment of Parkinson’s disease (PD). Objective: To study the clinical outcome and the predicting factors of efficacy of chronic STN stimulation, while DBS electrodes were implanted under local or general anaesthesia with intra-operative electrophysiological guidance based on multi-unit recordings. Methods: We included a large single-centre cohort of 54 patients with advanced PD (mean age: 59 years; disease duration: 14 years). Clinical evaluation was performed by the Unified Parkinson’s Disease Rating Scale (UPDRS) before and 1 year after surgical placement of DBS electrodes. Results: In the on-stimulation and off-medication condition, the UPDRS part III score was reduced by 56% compared to the off-stimulation condition or pre-operative off-drug score. In the on-stimulation and on-medication condition, this score was reduced by 73%. The severity of motor fluctuations and dyskinesia (UPDRS part IV) and the activities of daily living (UPDRS part II) were reduced by 65 and 80%, respectively, in the on-stimulation/on-medication condition compared to the pre-operative baseline. The daily dose of antiparkinsonian treatment was diminished by 72%. Among the various pre- and intra-operative data, the most important predictive factor for clinical efficacy of STN stimulation was the length of hyperactivity along the best track observed in intra-operative multi-unit recordings. Other predictive factors included age, disease duration and pre-operative levodopa responsiveness or baseline off-drug values of the Hoehn and Yahr and UPDRS part III scores. In contrast, the type of anaesthesia (local vs. general) did not significantly influence the clinical outcome. Conclusion: The present results are in the average of previously published results, but they have been obtained from a large single-centre cohort of patients with important reductions in the daily dose of antiparkinsonian drugs. This study confirmed the efficacy of the STN-DBS technique and emphasized the value of an original intra-operative electrophysiological approach based on multi-unit and not single-unit quantified recordings. This method allows DBS electrode implantation to be safely performed under general anaesthesia without lessening the rate of efficacy of the procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Various predictive factors for STN-DBS efficacy have been reported, including higher motor score at baseline, pre-operative levodopa responsiveness, age and disease duration [8,9,10,11,12,13,14]. The objective of the present study was to reappraise these factors in a large single-centre cohort of 54 patients.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Bilateral Subthalamic Nucleus Stimulation in the Treatment of Parkinson’s Disease: Correlation with Intra-Operative Multi-Unit Recordings but Not with the Type of Anaesthesia

Lefaucheur

Gurruchaga²,

Pollin³

et al. 2008

Eur Neurol

View full text Add to dashboard Cite

show abstract

“…1 The impact of axial symptoms on QOL reflects the limited response of these symptoms to the currently available pharmacological and surgical therapies. [2][3][4] There have now been several clinical studies of pedunculopontine nucleus (PPN) stimulation in humans showing variable results. Two initial case reports described stimulation of this nucleus in isolation, and an open label study reporting stimulation of the PPN in conjunction with stimulation of the subthalamic nucleus (STN) have reported positive outcomes.…”

Section: Introductionmentioning

confidence: 99%

Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson's disease

Khan

Mooney

Plaha

et al. 2011

British Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…24,28,29 Indeed, speech problems may arise at any stage of the disease process and are not necessarily related to the degree of motor disability. 30 Interestingly, speech intelligibility before surgery, off-or on-medication, was not a predictive factor of speech intelligibility at 1 year after surgery.…”

Section: Factors Associated With Speech Deterioration Following 1 Yeamentioning

confidence: 99%

Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease

Tripoliti¹,

Zrinzo²,

et al. 2011

View full text Add to dashboard Cite

Objective: Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short-and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change.Methods: Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on-and off-medication with on-and offstimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year. Results:Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2% Ϯ 20.15% off-medication and 16.9% Ϯ 21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6% Ϯ 5.5% and 4.5% Ϯ 8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year. Conclusion:The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients. Classification of evidence:This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1 month, 6 months, and 1 year compared to baseline and to control subjects treated with best medical therapy. Neurology

show abstract

Side‐effects of subthalamic stimulation in Parkinson's disease: clinical evolution and predictive factors

Cited by 73 publications

References 34 publications

Outcome of Bilateral Subthalamic Nucleus Stimulation in the Treatment of Parkinson’s Disease: Correlation with Intra-Operative Multi-Unit Recordings but Not with the Type of Anaesthesia

Outcome of Bilateral Subthalamic Nucleus Stimulation in the Treatment of Parkinson’s Disease: Correlation with Intra-Operative Multi-Unit Recordings but Not with the Type of Anaesthesia

Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson's disease

Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease

Contact Info

Product

Resources

About