| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Neurology (Drs. Vingerhoets, Temperli, and Ghika), Neurosurgery (Drs. Villemure and Pollo), and IBCM (Dr. Pralong), CHUV, Lausanne, Switzerland.
Address correspondence and reprint requests to Dr. F. Vingerhoets, Service de Neurologie, BH 13, CHUV, CH-1011 Lausanne, Switzerland; e-mail: francois.vingerhoets{at}chuv.hospvd.ch
Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) of patients with PD allows reduction of antiparkinsonian medication but has only a mild direct effect on dyskinesia. Since antiparkinsonian medication has short- and long-term effects that may prevent an estimate of the maximal possible impact of STN DBS, such medication was used at the lowest possible dosage after DBS implantation.
Objective: To study the maximal and long-term effects of STN DBS using the lowest dose of medication.
Methods: Twenty consecutive patients with PD with motor fluctuations and dyskinesia underwent bilateral implantation under stereotactic guidance, microrecording, and clinical control. All medications were stopped before implantation and reintroduced, at the lowest dosage needed, only if the postoperative motor score did not reach the baseline level. Unified PD Rating Scale (UPDRS) motor (subscale III) scores were measured at baseline and after 3, 6, 12, and 24 months.
Results: After 21 ± 8 months, the UPDRS III "off-medication" score was decreased by 45% and was similar to the preoperative UPDRS III "on" score. Overall, medication was reduced by 79%, being completely withdrawn in 10 patients. Fluctuations and dyskinesia showed an overall reduction of >90%, disappearing completely in patients without medication. These improvements were maintained for 2 years.
Conclusions: These results show that STN DBS could replace levodopa and allowed all antiparkinsonian medication to be discontinued in 50% of patients with PD. Fluctuations and dyskinesia disappeared completely in these patients but persisted in those still on medication. These improvements were maintained for 2 years.
This article has been cited by other articles:
|
|
 |
|
  W.M.M. Schupbach, D. Maltete, J. L. Houeto, S. T. du Montcel, L. Mallet, M. L. Welter, M. Gargiulo, C. Behar, A. M. Bonnet, V. Czernecki, et al. Neurosurgery at an earlier stage of Parkinson disease: A randomized, controlled trial Neurology, January 23, 2007; 68(4): 267 - 271. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Asanuma, C. Tang, Y. Ma, V. Dhawan, P. Mattis, C. Edwards, M. G. Kaplitt, A. Feigin, and D. Eidelberg Network modulation in the treatment of Parkinson's disease Brain, October 1, 2006; 129(10): 2667 - 2678. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Wider, H. Russmann, J.-G. Villemure, B. Robert, J. Bogousslavsky, P. R. Burkhard, and F. J. G. Vingerhoets Long-duration response to levodopa in patients with advanced Parkinson disease treated with subthalamic deep brain stimulation. Arch Neurol, July 1, 2006; 63(7): 951 - 955. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Rodriguez-Oroz, J. A. Obeso, A. E. Lang, J.-L. Houeto, P. Pollak, S. Rehncrona, J. Kulisevsky, A. Albanese, J. Volkmann, M. I. Hariz, et al. Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up Brain, October 1, 2005; 128(10): 2240 - 2249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sestini, S. Ramat, A. R. Formiconi, F. Ammannati, S. Sorbi, and A. Pupi Brain Networks Underlying the Clinical Effects of Long-Term Subthalamic Stimulation for Parkinson's Disease: A 4-Year Follow-up Study with rCBF SPECT J. Nucl. Med., September 1, 2005; 46(9): 1444 - 1454. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Iranzo, J. Santamaria, D. B. Rye, F. Valldeoriola, M. J. Marti, E. Munoz, I. Vilaseca, and E. Tolosa Characteristics of idiopathic REM sleep behavior disorder and that associated with MSA and PD Neurology, July 26, 2005; 65(2): 247 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Minguez-Castellanos, F Escamilla-Sevilla, M J Katati, J M Martin-Linares, M Meersmans, A Ortega-Moreno, and V Arjona Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease: target related effect or selection bias? J. Neurol. Neurosurg. Psychiatry, January 1, 2005; 76(1): 34 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Russmann, J. Ghika, J.-G. Villemure, B. Robert, J. Bogousslavsky, P. R. Burkhard, and F. J.G. Vingerhoets Subthalamic nucleus deep brain stimulation in Parkinson disease patients over age 70 years Neurology, November 23, 2004; 63(10): 1952 - 1954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M C Rodriguez-Oroz, I Zamarbide, J Guridi, M R Palmero, and J A Obeso Efficacy of deep brain stimulation of the subthalamic nucleus in Parkinson's disease 4 years after surgery: double blind and open label evaluation J. Neurol. Neurosurg. Psychiatry, October 1, 2004; 75(10): 1382 - 1385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B Ford, L Winfield, S L Pullman, S J Frucht, Y Du, P Greene, J H Cheringal, Q Yu, L J Cote, S Fahn, et al. Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year follow up J. Neurol. Neurosurg. Psychiatry, September 1, 2004; 75(9): 1255 - 1259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Russmann, J. Ghika, P. Combrement, J. G. Villemure, J. Bogousslavsky, P. R. Burkhard, and F. J.G. Vingerhoets L-Dopa-induced dyskinesia improvement after STN-DBS depends upon medication reduction Neurology, July 13, 2004; 63(1): 153 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Hershey, F. J. Revilla, A. Wernle, P. S. Gibson, J. L. Dowling, and J. S. Perlmutter Stimulation of STN impairs aspects of cognitive control in PD Neurology, April 13, 2004; 62(7): 1110 - 1114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B Gartner, M Seeck, C M Michel, J Delavelle, and F Lazeyras Patients with extratemporal lobe epilepsy do not differ from healthy subjects with respect to subcortical volumes J. Neurol. Neurosurg. Psychiatry, April 1, 2004; 75(4): 588 - 592. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Dujardin, S Blairy, L Defebvre, P Krystkowiak, U Hess, S Blond, and A Destee Subthalamic nucleus stimulation induces deficits in decoding emotional facial expressions in Parkinson's disease J. Neurol. Neurosurg. Psychiatry, February 1, 2004; 75(2): 202 - 208. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Devos, E. Labyt, P. Derambure, J. L. Bourriez, F. Cassim, N. Reyns, S. Blond, J. D. Guieu, A. Destee, and L. Defebvre Subthalamic nucleus stimulation modulates motor cortex oscillatory activity in Parkinson's disease Brain, February 1, 2004; 127(2): 408 - 419. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Temperli, J. Ghika, J.-G. Villemure, P.R. Burkhard, J. Bogousslavsky, and F.J.G. Vingerhoets How do parkinsonian signs return after discontinuation of subthalamic DBS? Neurology, January 14, 2003; 60(1): 78 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.E. Lang, G. Kleiner-Fisman, J.A. Saint-Cyr, J. Miyasaki, A. Lozano, J.L. Houeto, V. Mesnage, M.L. Welter, L. Mallet, Y. Agid, et al. Subthalamic DBS replaces levodopa in Parkinson's disease: Two-year follow-up Neurology, January 14, 2003; 60(1): 154 - 155. [Full Text] [PDF]
|
|
|
|
|
|
A. Berney, F. Vingerhoets, A. Perrin, P. Guex, J.-G. Villemure, P. R. Burkhard, C. Benkelfat, and J. Ghika Effect on mood of subthalamic DBS for Parkinson's disease A consecutive series of 24 patients Neurology, November 12, 2002; 59(9): 1427 - 1429. [Abstract] [Full Text] [PDF]
|
|
Read all Correspondence
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
