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Bilateral subthalamic nucleus stimulation for Parkinson's disease
P K Doshi1, N A Chhaya, M A Bhatt
1Jaslok Hospital and Research Centre, Mumbai, India. pareshkd@vsnl.com
Neurology India
|July 17, 2003
Summary
High-frequency stimulation of the subthalamic nucleus (STN) significantly improved motor function and daily living activities in advanced Parkinson's disease patients. This effective treatment reduced medication needs and Parkinson's symptoms without affecting cognitive function.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Advanced Parkinson's disease presents significant motor and non-motor symptoms.
- Subthalamic nucleus (STN) deep brain stimulation is a therapeutic option for Parkinson's disease.
- Levodopa-induced dyskinesias are a common complication of Parkinson's disease treatment.
Purpose of the Study:
- To evaluate the efficacy of high-frequency bilateral STN stimulation in patients with advanced Parkinson's disease.
- To assess the impact of STN stimulation on motor symptoms, activities of daily living, and medication requirements.
- To determine the effect of STN stimulation on cognitive function and identify potential adverse events.
Main Methods:
- Twenty-three patients with advanced Parkinson's disease (Hoehn and Yahr Stages III-V) underwent bilateral STN electrode implantation.
- Preoperative and 12-month postoperative assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr staging, and Activities of Daily Living (ADL) scores.
- Patients were evaluated in both "on" and "off" medication states, with video recordings used for objective assessment.
Main Results:
- One-year post-stimulation, UPDRS motor scores (Part III) and ADL scores (Part II) improved by 61% and 62% respectively (p<0.0005) in the "off" medication state.
- Significant improvements were observed in akinesia, rigidity, tremor, and gait subscores (p<0.0005).
- Average levodopa dosage decreased from 813 mg to 359 mg, and cognitive functions remained stable. Two patients experienced device complications, and two had weight gain.
Conclusions:
- Bilateral STN stimulation is a highly effective treatment for advanced Parkinson's disease, significantly improving motor symptoms and daily functioning.
- The procedure reduces the severity of "off" phase symptoms and axial symptoms, while also decreasing levodopa requirements.
- Reduced levodopa dosage is beneficial for managing drug-induced dyskinesias, with cognitive functions generally preserved.