Background Although the short-term benefits of bilateral stimulationof the subthalamic nucleus in patients with advanced Parkinson'sdisease have been well documented, the long-term outcomes ofthe procedure are unknown.
Methods We conducted a five-year prospective study of the first49 consecutive patients whom we treated with bilateral stimulationof the subthalamic nucleus. Patients were assessed at one, three,and five years with levodopa (on medication) and without levodopa(off medication), with use of the Unified Parkinson's DiseaseRating Scale. Seven patients did not complete the study: threedied, and four were lost to follow-up.
Results As compared with base line, the patients' scores atfive years for motor function while off medication improvedby 54 percent (P<0.001) and those for activities of dailyliving improved by 49 percent (P<0.001). Speech was the onlymotor function for which off-medication scores did not improve.The scores for motor function on medication did not improveone year after surgery, except for the dyskinesia scores. On-medicationakinesia, speech, postural stability, and freezing of gait worsenedbetween year 1 and year 5 (P<0.001 for all comparisons).At five years, the dose of dopaminergic treatment and the durationand severity of levodopa-induced dyskinesia were reduced, ascompared with base line (P<0.001 for each comparison). Theaverage scores for cognitive performance remained unchanged,but dementia developed in three patients after three years.Mean depression scores remained unchanged. Severe adverse eventsincluded a large intracerebral hemorrhage in one patient. Onepatient committed suicide.
Conclusions Patients with advanced Parkinson's disease who weretreated with bilateral stimulation of the subthalamic nucleushad marked improvements over five years in motor function whileoff medication and in dyskinesia while on medication. Therewas no control group, but worsening of akinesia, speech, posturalstability, freezing of gait, and cognitive function betweenthe first and the fifth year is consistent with the naturalhistory of Parkinson's disease.
Source Information
From the Departments of Clinical and Biological Neurosciences (P.K., A. Batir, N.V.B., S.C., V.F., C.A., A.K., P.D.L., A. Benazzouz, A.-L.B., P.P.) and Magnetic Resonance Imaging (J.F.L.), Joseph Fourier University, Grenoble, France.
Address reprint requests to Dr. Krack at the Department of Clinical and Biological Neurosciences, Département de Neurologie, Centre Hospitalier Universitaire de Grenoble, BP 217, 38043 Grenoble CEDEX 9, France, or at paul.krack{at}ujf-grenoble.fr.
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