Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up
Identifieur interne : 000256 ( France/Analysis ); précédent : 000255; suivant : 000257Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up
Auteurs : 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 ; N. P. Quinn ; J. D. Speelman [Pays-Bas] ; J. Guridi ; I. Zamarbide ; A. Gironell ; J. Molet ; B. Pascual-Sedano ; B. Pidoux ; A. M. Bonnet ; Yves Agid [France] ; J. Xie ; A.-L. Benabid ; A. M. Lozano ; J. Saint-Cyr ; L. Romito ; M. F. Contarino [Italie] ; M. Scerrati ; V. Fraix ; N. Van BlercomSource :
- Brain [ 0006-8950 ] ; 2005-10.
English descriptors
- KwdEn :
- ADL = activities of daily living, AEs = adverse events, DBS = deep brain stimulation, GPi = globus pallidus pars interna, Parkinson's disease, STN = subthalamic nucleus, UPDRS = Unified Parkinson's Disease Rating Scale, deep brain stimulation, globus pallidus pars interna, long-term effects, subthalamic nucleus.
Abstract
Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6–12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n = 49) or globus pallidus internus (GPi, n = 20) included in a multicentre study. Patients were assessed preoperatively and at 1 year and 3–4 years after surgery. The primary outcome measure was the change in the ‘off’ medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) at 3–4 years. Stimulation of the STN or GPi induced a significant improvement (50 and 39%; P < 0.0001) of the ‘off’ medication UPDRS-III score at 3–4 years with respect to baseline. Stimulation improved cardinal features and activities of daily living (ADL) (P < 0.0001 and P < 0.02 for STN and GPi, respectively) and prolonged the ‘on’ time spent with good mobility without dyskinesias (P < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P < 0.001). Comparison of the improvement induced by stimulation at 1 year with 3–4 years showed a significant worsening in the ‘on’ medication motor states of the UPDRS-III, ADL and gait in both STN and GPi groups, and speech and postural stability in the STN-treated group. Adverse events (AEs) included cognitive decline, speech difficulty, instability, gait disorders and depression. These were more common in patients treated with DBS of the STN. No patient abandoned treatment as a result of these side effects. This experience, which represents the first multicentre study assessing the long-term efficacy of either STN or GPi stimulation, shows a significant and substantial clinically important therapeutic benefit for at least 3–4 years in a large cohort of patients with severe Parkinson's disease.
Url:
DOI: 10.1093/brain/awh571
Affiliations:
- France, Italie, Pays-Bas
- Hollande-Septentrionale, Latium, Île-de-France
- Amsterdam, Paris, Rome
- Hôpital de la Salpêtrière
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ISTEX:860820614185D44B4C30C80E241B21643A5636C0Le document en format XML
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Bonnet</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Yves Agid</name><affiliation><country>France</country><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName><orgName type="hospital" n="4">Hôpital de la Salpêtrière</orgName></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry><country>France</country><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName><orgName type="hospital" n="4">Hôpital de la Salpêtrière</orgName></affiliation></author><author><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J." last="Xie">J. Xie</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. Benabid</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Saint Cyr, J" sort="Saint Cyr, J" uniqKey="Saint Cyr J" first="J." last="Saint-Cyr">J. Saint-Cyr</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Romito, L" sort="Romito, L" uniqKey="Romito L" first="L." last="Romito">L. Romito</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Contarino, M F" sort="Contarino, M F" uniqKey="Contarino M" first="M. F." last="Contarino">M. F. Contarino</name><affiliation wicri:level="3"><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation><affiliation></affiliation></author><author><name sortKey="Scerrati, M" sort="Scerrati, M" uniqKey="Scerrati M" first="M." last="Scerrati">M. Scerrati</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author><author><name sortKey="Van Blercom, N" sort="Van Blercom, N" uniqKey="Van Blercom N" first="N." last="Van Blercom">N. Van Blercom</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-10">2005-10</date><biblScope unit="volume">128</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="2240">2240</biblScope><biblScope unit="page" to="2249">2249</biblScope></imprint><idno type="ISSN">0006-8950</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ADL = activities of daily living</term><term>AEs = adverse events</term><term>DBS = deep brain stimulation</term><term>GPi = globus pallidus pars interna</term><term>Parkinson's disease</term><term>STN = subthalamic nucleus</term><term>UPDRS = Unified Parkinson's Disease Rating Scale</term><term>deep brain stimulation</term><term>globus pallidus pars interna</term><term>long-term effects</term><term>subthalamic nucleus</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6–12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n = 49) or globus pallidus internus (GPi, n = 20) included in a multicentre study. Patients were assessed preoperatively and at 1 year and 3–4 years after surgery. The primary outcome measure was the change in the ‘off’ medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) at 3–4 years. Stimulation of the STN or GPi induced a significant improvement (50 and 39%; P < 0.0001) of the ‘off’ medication UPDRS-III score at 3–4 years with respect to baseline. Stimulation improved cardinal features and activities of daily living (ADL) (P < 0.0001 and P < 0.02 for STN and GPi, respectively) and prolonged the ‘on’ time spent with good mobility without dyskinesias (P < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P < 0.001). Comparison of the improvement induced by stimulation at 1 year with 3–4 years showed a significant worsening in the ‘on’ medication motor states of the UPDRS-III, ADL and gait in both STN and GPi groups, and speech and postural stability in the STN-treated group. Adverse events (AEs) included cognitive decline, speech difficulty, instability, gait disorders and depression. These were more common in patients treated with DBS of the STN. No patient abandoned treatment as a result of these side effects. This experience, which represents the first multicentre study assessing the long-term efficacy of either STN or GPi stimulation, shows a significant and substantial clinically important therapeutic benefit for at least 3–4 years in a large cohort of patients with severe Parkinson's disease.</div></front></TEI><affiliations><list><country><li>France</li><li>Italie</li><li>Pays-Bas</li></country><region><li>Hollande-Septentrionale</li><li>Latium</li><li>Île-de-France</li></region><settlement><li>Amsterdam</li><li>Paris</li><li>Rome</li></settlement><orgName><li>Hôpital de la Salpêtrière</li></orgName></list><tree><noCountry><name sortKey="Albanese, A" sort="Albanese, A" uniqKey="Albanese A" first="A." last="Albanese">A. Albanese</name><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. Benabid</name><name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A. M." last="Bonnet">A. M. Bonnet</name><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><name sortKey="Gironell, A" sort="Gironell, A" uniqKey="Gironell A" first="A." last="Gironell">A. Gironell</name><name sortKey="Guridi, J" sort="Guridi, J" uniqKey="Guridi J" first="J." last="Guridi">J. Guridi</name><name sortKey="Hariz, M I" sort="Hariz, M I" uniqKey="Hariz M" first="M. I." last="Hariz">M. I. Hariz</name><name sortKey="Houeto, J L" sort="Houeto, J L" uniqKey="Houeto J" first="J.-L." last="Houeto">J.-L. Houeto</name><name sortKey="Kulisevsky, J" sort="Kulisevsky, J" uniqKey="Kulisevsky J" first="J." last="Kulisevsky">J. Kulisevsky</name><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><name sortKey="Molet, J" sort="Molet, J" uniqKey="Molet J" first="J." last="Molet">J. Molet</name><name sortKey="Obeso, J A" sort="Obeso, J A" uniqKey="Obeso J" first="J. A." last="Obeso">J. A. Obeso</name><name sortKey="Pascual Sedano, B" sort="Pascual Sedano, B" uniqKey="Pascual Sedano B" first="B." last="Pascual-Sedano">B. Pascual-Sedano</name><name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B." last="Pidoux">B. Pidoux</name><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><name sortKey="Quinn, N P" sort="Quinn, N P" uniqKey="Quinn N" first="N. P." last="Quinn">N. P. Quinn</name><name sortKey="Rehncrona, S" sort="Rehncrona, S" uniqKey="Rehncrona S" first="S." last="Rehncrona">S. Rehncrona</name><name sortKey="Rodriguez Oroz, M C" sort="Rodriguez Oroz, M C" uniqKey="Rodriguez Oroz M" first="M. C." last="Rodriguez-Oroz">M. C. Rodriguez-Oroz</name><name sortKey="Romito, L" sort="Romito, L" uniqKey="Romito L" first="L." last="Romito">L. Romito</name><name sortKey="Saint Cyr, J" sort="Saint Cyr, J" uniqKey="Saint Cyr J" first="J." last="Saint-Cyr">J. Saint-Cyr</name><name sortKey="Scerrati, M" sort="Scerrati, M" uniqKey="Scerrati M" first="M." last="Scerrati">M. Scerrati</name><name sortKey="Van Blercom, N" sort="Van Blercom, N" uniqKey="Van Blercom N" first="N." last="Van Blercom">N. Van Blercom</name><name sortKey="Volkmann, J" sort="Volkmann, J" uniqKey="Volkmann J" first="J." last="Volkmann">J. Volkmann</name><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J." last="Xie">J. Xie</name><name sortKey="Zamarbide, I" sort="Zamarbide, I" uniqKey="Zamarbide I" first="I." last="Zamarbide">I. Zamarbide</name></noCountry><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Speelman, J D" sort="Speelman, J D" uniqKey="Speelman J" first="J. D." last="Speelman">J. D. Speelman</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Yves Agid</name></region><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Yves Agid</name></country><country name="Italie"><region name="Latium"><name sortKey="Contarino, M F" sort="Contarino, M F" uniqKey="Contarino M" first="M. F." last="Contarino">M. F. Contarino</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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