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

Abstract

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.

Neuropsychological Outcome in Subthalamic Nucleus Stimulation Surgeries with Electrodes Passing through the Caudate Nucleus

“…The latter may show a consistent decline, whereas procedural consequences may recover in the longer term. Long-term onset of cognitive decline will probably be related to the progression of the disease [2]. …”

“…Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson Disease (PD) is a widely performed procedure, and the therapeutic effects have been documented extensively [1,2]. Concerning the effects on cognitive function, a decline in verbal fluency, response inhibition, and memory has been reported [3,4,5,6].…”

“…Concerning the effects on cognitive function, a decline in verbal fluency, response inhibition, and memory has been reported [3,4,5,6]. A long-term follow-up study showed a stepwise decrease in verbal fluency and response inhibition during 10 years after surgery compared to a baseline assessment prior to surgery, whereas verbal memory showed an improvement in the first year after surgery and a decrease from 1 to 10 years after surgery [2]. …”

Long-term effect of low frequency stimulation of STN on dysphagia, freezing of gait and other motor symptoms in PD

“…Bradykinesia could also benefit from LFS,12 30 as it was found to worsen with axial symptoms as the disease progresses 31…”

Final electrode position in subthalamic nucleus deep brain stimulation surgery: a comparison of indirect and direct targeting methods

“…The longterm therapeutic effects have been documented by numerous clinical studies (4,8). The most prominent determinants of the success of this therapy are the selection of patients and the accuracy of targeting the STN.…”