Background In many patients with idiopathic Parkinson's disease,treatment with levodopa is complicated by fluctuations betweenan "off" period (also referred to as "off medication"), whenthe medication is not working and the motor symptoms of parkinsonismare present, and an "on" period, when the medication is causingimproved mobility (also referred to as "on medication"), oftenaccompanied by debilitating dyskinesias. In animal models ofParkinson's disease, there is overactivity in the subthalamicnucleus, and electrical stimulation of the subthalamic nucleusimproves parkinsonism. We therefore sought to determine theefficacy and safety of electrical stimulation of the subthalamicnucleus in patients with Parkinson's disease.
Methods We studied 24 patients with idiopathic Parkinson's diseasein whom electrodes were implanted bilaterally in the subthalamicnucleus under stereotactic guidance with imaging and electrophysiologictesting of the location. Twenty were followed for at least 12months. Clinical evaluations included the Unified Parkinson'sDisease Rating Scale, a dyskinesia scale, and timed tests conductedbefore and after surgery, when patients were off and on medications.
Results After one year of electrical stimulation of the subthalamicnucleus, the patients' scores for activities of daily livingand motor examination scores (Unified Parkinson's Disease RatingScale parts II and III, respectively) off medication improvedby 60 percent (P<0.001). The subscores improved for limbakinesia, rigidity, tremor, and gait. In the testing done onmedication, the scores on part III improved by 10 percent (P<0.005).The mean dose of dopaminergic drugs was reduced by half. Thecognitive-performance scores remained unchanged, but one patienthad paralysis and aphasia after an intracerebral hematoma duringthe implantation procedure.
Conclusions Electrical stimulation of the subthalamic nucleusis an effective treatment for advanced Parkinson's disease.The severity of symptoms off medication decreases, and the doseof levodopa can be reduced, with a consequent reduction in dyskinesias.
Source Information
From the Department of Clinical and Biologic Neurosciences, Joseph Fourier University, Grenoble, France (P.L., P.K., P.P., A.B., C.A., D.H., A.-L.B.); the Medical Research Council Human Movement and Balance Unit, Queen Square, London (P.L.); and the Neurology Department, University of Kiel, Kiel, Germany (P.K.).
Address reprint requests to Dr. Pollak at the Department of Clinical and Biologic Neurosciences, Joseph Fourier University, B.P. 217, 38043 Grenoble CEDEX 9, France.
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