Ten-Year Outcome of Subthalamic Stimulation in Parkinson Disease

Castrioto, Anna; Lozano, Andrés M.; Poon, Yu‐Yan; Lang, Anthony E.; Fallis, Melanie; Moro, Elena

doi:10.1001/archneurol.2011.182

Cited by 403 publications

(396 citation statements)

References 23 publications

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“…Our findings agree with what observed in other studies [6], [7] and [8], and could be chiefly explained by the progression of the disease over time [16]. While the cardinal PD symptoms keep on improving with stimulation, there is a progressive emerging of poorly levodopa-responsive symptoms, mainly axial symptoms, speech problems and postural instability.…”

Section: Discussionsupporting

confidence: 92%

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Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Rizzone

Fasano

Daniele

et al. 2014

Parkinsonism & Related Disorders

161

152

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Background: Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome.Objective: To report the results of a long-term follow-up (mean 11 years, range 10-13) on 26 patients bilaterally implanted in two centres. Methods:Patients were assessed preoperatively and 1, 5 and 11 years after the implant by the Unified Parkinson's Disease Rating Scale (UPDRS) and a battery of neuropsychological tests. Stimulation parameters, drugs dosages, non-motor symptoms and adverse events were also recorded.Results: At 11 years, stimulation significantly improved the motor symptoms by 35.8%, as compared to the preoperative off-state. Motor complications were well controlled, with a 84.6% improvement of dyskinesias and a 65.8% improvement of motor fluctuations. Despite this, the UPDRS-II-on score worsened by 88.5%, mainly for the worsening of poorly levodopa-responsive symptoms. More than 70% of the patients performed in the normal range in most of the neuropsychological tests, despite the development of dementia in 22.7%. Age at disease onset, axial subscore in off-condition and presence of REM behaviour disorder at baseline were found to be associated with a higher risk of developing disability over time. Conclusions:Our study confirms the long-term safety and efficacy of STN-DBS in PD. Nevertheless, the functionality of patients worsens over time, mainly for the onset and progression of levodopa-resistant and non-motor symptoms. The role of PD-subtype seems to be relevant in the long-term outcome.

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Section: Discussionsupporting

confidence: 92%

“…STN-DBS efficacy on PD motor symptoms is well documented in the short-and medium-term, up to 5-6 years [4] and [5], while a few papers with a small number of examined patients addressed the long-term efficacy of this procedure [6], [7] and [8].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Rizzone

Fasano

Daniele

et al. 2014

Parkinsonism & Related Disorders

161

152

View full text Add to dashboard Cite

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“…The subthalamic nucleus (STN) is a key structure in the basal ganglia-thalamo-cortical motor cir- cuit, and DBS of the STN showed striking improvements, of 41-55%, in motor function (5,(7)(8)(9)(10). The globus pallidus internus (GPi) is also an important stimulation target, demonstrating similar improvements in motor symptoms to STN DBS.…”

Section: Current Practice Of Stereotactic Ign Deep Brain Stimulation mentioning

confidence: 99%

Image-guided Stereotactic Neurosurgery: Practices and Pitfalls

Jung¹,

Kim²,

Kim³

et al. 2015

Journal of International Society for Simulation Surgery

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Image-guided neurosurgery (IGN) is a technique for localizing objects of surgical interest within the brain. In the past, its main use was placement of electrodes; however, the advent of computed tomography has led to a rebirth of IGN. Advances in computing techniques and neuroimaging tools allow improved surgical planning and intraoperative information. IGN influences many neurosurgical fields including neuro-oncology, functional disease, and radiosurgery. As development continues, several problems remain to be solved. This article provides a general overview of IGN with a brief discussion of future directions.

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“…Depression has been described as a common side-effect following STN DBS (Houeto et al, 2002). However, the pictures depicted by large randomized controlled trials (Deuschl et al, 2006;Witt et al, 2008;Weaver et al, 2009) and from long-term outcome studies Castrioto et al, 2011a) differ as, in the former, measures of depression were found to be slightly improved in the surgery group whereas in the latter depression was not described as a frequent sideeffect. The main risk factors for the occurrence of postoperative depression include preoperative history of depression, rapid or excessive dopaminergic medication withdrawal, and difficulties adjusting to life-changing surgery (Agid et al, 2006;Volkmann et al, 2010).…”

Section: Chronic Issuesmentioning

confidence: 99%