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NEUROLOGY 1998;51:850-855
© 1998 American Academy of Neurology

Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease

R. Kumar, MD, A. M. Lozano, MD, PhD, Y. J. Kim, MD, W. D. Hutchison, PhD, E. Sime, RN, E. Halket, RN and A. E. Lang, MD

From the Divisions of Neurology (Drs. Kumar, Kim, and Lang, and E. Sime and E. Halket) and Neurosurgery (Drs. Lozano and Hutchison), Faculty of Medicine, University of Toronto, Canada.

Address correspondence and reprint requests to Dr. Anthony E. Lang, The Toronto Hospital Movement Disorders Centre, 399 Bathurst St., MP 11-306, Toronto, Ontario, Canada M5T 2S8.

Objective: To examine objectively the clinical effects of subthalamic nucleus (STN) deep brain stimulation (DBS) in advanced PD.

Methods: Our initial seven consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic STN DBS underwent a standardized preoperative evaluation followed by a 2-day double-blind evaluation of efficacy 6 to 12 months after electrode implantation. Diaries documenting motor fluctuations and dyskinesias were also completed preoperatively and postoperatively.

Results: In the medication-off state, turning the stimulators on resulted in improvement in mean total Unified Parkinson's Disease Rating Scale (UPDRS) motor score by 58% including the following improvements in composite scores: akinesia 57%, rigidity 52%, tremor 82%, and gait and postural stability 49%. Additionally, the medication-off state improved 17% without stimulation, possibly as a result of electrode insertion alone or carry-over of chronic stimulation. In the medication-on, stimulation-on state, all major features of parkinsonism improved and total UPDRS motor score improved 41% compared with before surgery. Activities of daily living were improved while off medication 30%, and levodopa-induced dyskinesias were reduced 83% while total drug dosage was decreased 40%. With chronic stimulation, patients reported that the percentage of time spent in the "on" state (without dyskinesias) increased from 26% to 52% and "off" time decreased from 30% to 6%. Operative complications including cognitive worsening were not uncommon.

Conclusions: STN DBS is a promising new surgical option for the treatment of advanced PD. The marked clinical benefits obtained in these severely disabled patients outweighed the adverse effects.

Supported in part by the Parkinson Foundation of Canada (A.M.L.), a Centre of Excellence grant from the National Parkinson Foundation (A.E.L.), and Medtronic Neurological. Dr. Lozano is a Medical Research Council of Canada Clinical Scientist.

Received June 29, 1998. Accepted in final form July 16, 1998.




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Therapeutics in the Neurorehabilitation of Parkinson's Disease
Neurorehabil Neural Repair, December 1, 1999; 13(4): 205 - 218.
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M. Hallett and I. Litvan
Evaluation of surgery for Parkinson's disease: A Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
Neurology, December 1, 1999; 53(9): 1910 - 1910.
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P. Ashby, Y. J. Kim, R. Kumar, A. E. Lang, and A. M. Lozano
Neurophysiological effects of stimulation through electrodes in the human subthalamic nucleus
Brain, October 1, 1999; 122(10): 1919 - 1931.
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R. Kumar, A. M. Lozano, E. Sime, E. Halket, and A. E. Lang
Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation
Neurology, August 1, 1999; 53(3): 561 - 561.
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E. Moro, M. Scerrati, L. M. A. Romito, R. Roselli, P. Tonali, and A. Albanese
Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson's disease
Neurology, July 1, 1999; 53(1): 85 - 85.
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B.-P. Bejjani, P. Damier, I. Arnulf, L. Thivard, A.-M. Bonnet, D. Dormont, P. Cornu, B. Pidoux, Y. Samson, and Y. Agid
Transient Acute Depression Induced by High-Frequency Deep-Brain Stimulation
N. Engl. J. Med., May 13, 1999; 340(19): 1476 - 1480.
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