Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up
Identifieur interne : 002B16 ( Istex/Corpus ); précédent : 002B15; suivant : 002B17Bilateral 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 ; J. Guridi ; I. Zamarbide ; A. Gironell ; J. Molet ; B. Pascual-Sedano ; B. Pidoux ; A. M. Bonnet ; Y. Agid ; J. Xie ; A.-L. Benabid ; A. M. Lozano ; J. Saint-Cyr ; L. Romito ; M. F. Contarino ; 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
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ISTEX:860820614185D44B4C30C80E241B21643A5636C0Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</title><author><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><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Obeso, J A" sort="Obeso, J A" uniqKey="Obeso J" first="J. A." last="Obeso">J. A. Obeso</name><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><affiliation><mods:affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Houeto, J L" sort="Houeto, J L" uniqKey="Houeto J" first="J.-L." last="Houeto">J.-L. Houeto</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><affiliation><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Rehncrona, S" sort="Rehncrona, S" uniqKey="Rehncrona S" first="S." last="Rehncrona">S. Rehncrona</name><affiliation><mods:affiliation>Neurosurgery Service, Lund University Hospital, Sweden,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Kulisevsky, J" sort="Kulisevsky, J" uniqKey="Kulisevsky J" first="J." last="Kulisevsky">J. Kulisevsky</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Albanese, A" sort="Albanese, A" uniqKey="Albanese A" first="A." last="Albanese">A. Albanese</name><affiliation><mods:affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Volkmann, J" sort="Volkmann, J" uniqKey="Volkmann J" first="J." last="Volkmann">J. Volkmann</name><affiliation><mods:affiliation>Neurologische Klinik der Christian-Albrecht-Universität, Kiel, Germany,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Hariz, M I" sort="Hariz, M I" uniqKey="Hariz M" first="M. I." last="Hariz">M. I. Hariz</name><affiliation><mods:affiliation>Institute of Neurology, Queen Square, London, UK,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Quinn, N P" sort="Quinn, N P" uniqKey="Quinn N" first="N. P." last="Quinn">N. P. Quinn</name><affiliation><mods:affiliation>Institute of Neurology, Queen Square, London, UK,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Speelman, J D" sort="Speelman, J D" uniqKey="Speelman J" first="J. D." last="Speelman">J. D. Speelman</name><affiliation><mods:affiliation>Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands and</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Guridi, J" sort="Guridi, J" uniqKey="Guridi J" first="J." last="Guridi">J. Guridi</name><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Zamarbide, I" sort="Zamarbide, I" uniqKey="Zamarbide I" first="I." last="Zamarbide">I. Zamarbide</name><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Gironell, A" sort="Gironell, A" uniqKey="Gironell A" first="A." last="Gironell">A. Gironell</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Molet, J" sort="Molet, J" uniqKey="Molet J" first="J." last="Molet">J. Molet</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Pascual Sedano, B" sort="Pascual Sedano, B" uniqKey="Pascual Sedano B" first="B." last="Pascual-Sedano">B. Pascual-Sedano</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B." last="Pidoux">B. Pidoux</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A. M." last="Bonnet">A. M. Bonnet</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Y. Agid</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J." last="Xie">J. Xie</name><affiliation><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Romito, L" sort="Romito, L" uniqKey="Romito L" first="L." last="Romito">L. Romito</name><affiliation><mods:affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Scerrati, M" sort="Scerrati, M" uniqKey="Scerrati M" first="M." last="Scerrati">M. Scerrati</name><affiliation><mods:affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><affiliation><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:860820614185D44B4C30C80E241B21643A5636C0</idno><date when="2005" year="2005">2005</date><idno type="doi">10.1093/brain/awh571</idno><idno type="url">https://api-v5.istex.fr/document/860820614185D44B4C30C80E241B21643A5636C0/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002B16</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002B16</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</title><author><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><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Obeso, J A" sort="Obeso, J A" uniqKey="Obeso J" first="J. A." last="Obeso">J. A. Obeso</name><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><affiliation><mods:affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Houeto, J L" sort="Houeto, J L" uniqKey="Houeto J" first="J.-L." last="Houeto">J.-L. Houeto</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><affiliation><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Rehncrona, S" sort="Rehncrona, S" uniqKey="Rehncrona S" first="S." last="Rehncrona">S. Rehncrona</name><affiliation><mods:affiliation>Neurosurgery Service, Lund University Hospital, Sweden,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Kulisevsky, J" sort="Kulisevsky, J" uniqKey="Kulisevsky J" first="J." last="Kulisevsky">J. Kulisevsky</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Albanese, A" sort="Albanese, A" uniqKey="Albanese A" first="A." last="Albanese">A. Albanese</name><affiliation><mods:affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Volkmann, J" sort="Volkmann, J" uniqKey="Volkmann J" first="J." last="Volkmann">J. Volkmann</name><affiliation><mods:affiliation>Neurologische Klinik der Christian-Albrecht-Universität, Kiel, Germany,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Hariz, M I" sort="Hariz, M I" uniqKey="Hariz M" first="M. I." last="Hariz">M. I. Hariz</name><affiliation><mods:affiliation>Institute of Neurology, Queen Square, London, UK,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Quinn, N P" sort="Quinn, N P" uniqKey="Quinn N" first="N. P." last="Quinn">N. P. Quinn</name><affiliation><mods:affiliation>Institute of Neurology, Queen Square, London, UK,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Speelman, J D" sort="Speelman, J D" uniqKey="Speelman J" first="J. D." last="Speelman">J. D. Speelman</name><affiliation><mods:affiliation>Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands and</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Guridi, J" sort="Guridi, J" uniqKey="Guridi J" first="J." last="Guridi">J. Guridi</name><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Zamarbide, I" sort="Zamarbide, I" uniqKey="Zamarbide I" first="I." last="Zamarbide">I. Zamarbide</name><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Gironell, A" sort="Gironell, A" uniqKey="Gironell A" first="A." last="Gironell">A. Gironell</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Molet, J" sort="Molet, J" uniqKey="Molet J" first="J." last="Molet">J. Molet</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Pascual Sedano, B" sort="Pascual Sedano, B" uniqKey="Pascual Sedano B" first="B." last="Pascual-Sedano">B. Pascual-Sedano</name><affiliation><mods:affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B." last="Pidoux">B. Pidoux</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A. M." last="Bonnet">A. M. Bonnet</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Y. Agid</name><affiliation><mods:affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J." last="Xie">J. Xie</name><affiliation><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Romito, L" sort="Romito, L" uniqKey="Romito L" first="L." last="Romito">L. Romito</name><affiliation><mods:affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Scerrati, M" sort="Scerrati, M" uniqKey="Scerrati M" first="M." last="Scerrati">M. Scerrati</name><affiliation><mods:affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></affiliation></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><affiliation><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><mods:affiliation>Service de Neurologie, University Hospital of Grenoble, France,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</mods:affiliation></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><istex><corpusName>oup</corpusName><author><json:item><name>M. C. Rodriguez-Oroz</name><affiliations><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. A. Obeso</name><affiliations><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>A. E. Lang</name><affiliations><json:string>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J.-L. Houeto</name><affiliations><json:string>Groupe Hospitalier Pitié-Salpetrière, Paris,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>P. Pollak</name><affiliations><json:string>Service de Neurologie, University Hospital of Grenoble, France,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>S. Rehncrona</name><affiliations><json:string>Neurosurgery Service, Lund University Hospital, Sweden,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. Kulisevsky</name><affiliations><json:string>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>A. Albanese</name><affiliations><json:string>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. Volkmann</name><affiliations><json:string>Neurologische Klinik der Christian-Albrecht-Universität, Kiel, Germany,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>M. I. Hariz</name><affiliations><json:string>Institute of Neurology, Queen Square, London, UK,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>N. P. Quinn</name><affiliations><json:string>Institute of Neurology, Queen Square, London, UK,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. D. Speelman</name><affiliations><json:string>Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands and</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. Guridi</name><affiliations><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>I. Zamarbide</name><affiliations><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>A. Gironell</name><affiliations><json:string>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. Molet</name><affiliations><json:string>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>B. Pascual-Sedano</name><affiliations><json:string>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>B. Pidoux</name><affiliations><json:string>Groupe Hospitalier Pitié-Salpetrière, Paris,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>A. M. Bonnet</name><affiliations><json:string>Groupe Hospitalier Pitié-Salpetrière, Paris,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>Y. Agid</name><affiliations><json:string>Groupe Hospitalier Pitié-Salpetrière, Paris,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. Xie</name><affiliations><json:string>Service de Neurologie, University Hospital of Grenoble, France,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>A.-L. Benabid</name><affiliations><json:string>Service de Neurologie, University Hospital of Grenoble, France,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>A. M. Lozano</name><affiliations><json:string>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>J. Saint-Cyr</name><affiliations><json:string>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>L. Romito</name><affiliations><json:string>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>M. F. Contarino</name><affiliations><json:string>Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome, Italy</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>M. Scerrati</name><affiliations><json:string>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>V. Fraix</name><affiliations><json:string>Service de Neurologie, University Hospital of Grenoble, France,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item><json:item><name>N. Van Blercom</name><affiliations><json:string>Service de Neurologie, University Hospital of Grenoble, France,</json:string><json:string>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>globus pallidus pars interna</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>long-term effects</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ADL = activities of daily living</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>AEs = adverse events</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>DBS = deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>GPi = globus pallidus pars interna</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STN = subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UPDRS = Unified Parkinson's Disease Rating Scale</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><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.</abstract><qualityIndicators><score>10</score><pdfWordCount>6324</pdfWordCount><pdfCharCount>40069</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>10</pdfPageCount><pdfPageSize>612.288 x 793.706 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>313</abstractWordCount><abstractCharCount>1985</abstractCharCount><keywordCount>11</keywordCount></qualityIndicators><title>Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</title><genre><json:string>research-article</json:string></genre><host><title>Brain</title><language><json:string>unknown</json:string></language><issn><json:string>0006-8950</json:string></issn><eissn><json:string>1460-2156</json:string></eissn><publisherId><json:string>brainj</json:string></publisherId><volume>128</volume><issue>10</issue><pages><first>2240</first><last>2249</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>neurosciences</json:string><json:string>clinical neurology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>neurology & neurosurgery</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>2005</publicationDate><copyrightDate>2005</copyrightDate><doi><json:string>10.1093/brain/awh571</json:string></doi><id>860820614185D44B4C30C80E241B21643A5636C0</id><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api-v5.istex.fr/document/860820614185D44B4C30C80E241B21643A5636C0/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api-v5.istex.fr/document/860820614185D44B4C30C80E241B21643A5636C0/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api-v5.istex.fr/document/860820614185D44B4C30C80E241B21643A5636C0/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org</p></availability><date>2005-06-23</date></publicationStmt><notesStmt><note>Correspondence to: Prof J. A. Obeso, Neurologia-Neurociencias, Clinica Universitaria, Facultad de Medicina, Avenida de Pio XII, 36, Pamplona, 31008, Spain E-mail: jobeso@unav.es</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</title><author xml:id="author-0000"><persName><forename type="first">M. C.</forename><surname>Rodriguez-Oroz</surname></persName><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0001"><persName><forename type="first">J. A.</forename><surname>Obeso</surname></persName><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0002"><persName><forename type="first">A. E.</forename><surname>Lang</surname></persName><affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0003"><persName><forename type="first">J.-L.</forename><surname>Houeto</surname></persName><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0004"><persName><forename type="first">P.</forename><surname>Pollak</surname></persName><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0005"><persName><forename type="first">S.</forename><surname>Rehncrona</surname></persName><affiliation>Neurosurgery Service, Lund University Hospital, Sweden,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0006"><persName><forename type="first">J.</forename><surname>Kulisevsky</surname></persName><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0007"><persName><forename type="first">A.</forename><surname>Albanese</surname></persName><affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0008"><persName><forename type="first">J.</forename><surname>Volkmann</surname></persName><affiliation>Neurologische Klinik der Christian-Albrecht-Universität, Kiel, Germany,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0009"><persName><forename type="first">M. I.</forename><surname>Hariz</surname></persName><affiliation>Institute of Neurology, Queen Square, London, UK,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0010"><persName><forename type="first">N. P.</forename><surname>Quinn</surname></persName><affiliation>Institute of Neurology, Queen Square, London, UK,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0011"><persName><forename type="first">J. D.</forename><surname>Speelman</surname></persName><affiliation>Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands and</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0012"><persName><forename type="first">J.</forename><surname>Guridi</surname></persName><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0013"><persName><forename type="first">I.</forename><surname>Zamarbide</surname></persName><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0014"><persName><forename type="first">A.</forename><surname>Gironell</surname></persName><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0015"><persName><forename type="first">J.</forename><surname>Molet</surname></persName><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0016"><persName><forename type="first">B.</forename><surname>Pascual-Sedano</surname></persName><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0017"><persName><forename type="first">B.</forename><surname>Pidoux</surname></persName><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0018"><persName><forename type="first">A. M.</forename><surname>Bonnet</surname></persName><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0019"><persName><forename type="first">Y.</forename><surname>Agid</surname></persName><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0020"><persName><forename type="first">J.</forename><surname>Xie</surname></persName><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0021"><persName><forename type="first">A.-L.</forename><surname>Benabid</surname></persName><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0022"><persName><forename type="first">A. M.</forename><surname>Lozano</surname></persName><affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0023"><persName><forename type="first">J.</forename><surname>Saint-Cyr</surname></persName><affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0024"><persName><forename type="first">L.</forename><surname>Romito</surname></persName><affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0025"><persName><forename type="first">M. F.</forename><surname>Contarino</surname></persName><affiliation>Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome, Italy</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0026"><persName><forename type="first">M.</forename><surname>Scerrati</surname></persName><affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0027"><persName><forename type="first">V.</forename><surname>Fraix</surname></persName><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><author xml:id="author-0028"><persName><forename type="first">N.</forename><surname>Van Blercom</surname></persName><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation></author><idno type="istex">860820614185D44B4C30C80E241B21643A5636C0</idno><idno type="DOI">10.1093/brain/awh571</idno><idno type="local">awh571</idno></analytic><monogr><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="pISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><idno type="PublisherID">brainj</idno><idno type="PublisherID-hwp">brain</idno><idno type="PublisherID-nlm-ta">Brain</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="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></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2005-06-23</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>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.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>deep brain stimulation</term></item><item><term>globus pallidus pars interna</term></item><item><term>long-term effects</term></item><item><term>Parkinson's disease</term></item><item><term>subthalamic nucleus</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>ADL = activities of daily living</term></item><item><term>AEs = adverse events</term></item><item><term>DBS = deep brain stimulation</term></item><item><term>GPi = globus pallidus pars interna</term></item><item><term>STN = subthalamic nucleus</term></item><item><term>UPDRS = Unified Parkinson's Disease Rating Scale</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2005-06-23">Created</change><change when="2005-10">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api-v5.istex.fr/document/860820614185D44B4C30C80E241B21643A5636C0/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">brain</journal-id><journal-id journal-id-type="nlm-ta">Brain</journal-id><journal-id journal-id-type="publisher-id">brainj</journal-id><journal-title>Brain</journal-title><abbrev-journal-title abbrev-type="publisher">Brain</abbrev-journal-title><issn pub-type="ppub">0006-8950</issn><issn pub-type="epub">1460-2156</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">awh571</article-id><article-id pub-id-type="doi">10.1093/brain/awh571</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Rodriguez-Oroz</surname><given-names>M. C.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Obeso</surname><given-names>J. A.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lang</surname><given-names>A. E.</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Houeto</surname><given-names>J.-L.</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author"><name><surname>Pollak</surname><given-names>P.</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Rehncrona</surname><given-names>S.</given-names></name><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author"><name><surname>Kulisevsky</surname><given-names>J.</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author"><name><surname>Albanese</surname><given-names>A.</given-names></name><xref rid="AFF7">7</xref></contrib><contrib contrib-type="author"><name><surname>Volkmann</surname><given-names>J.</given-names></name><xref rid="AFF8">8</xref></contrib><contrib contrib-type="author"><name><surname>Hariz</surname><given-names>M. I.</given-names></name><xref rid="AFF9">9</xref></contrib><contrib contrib-type="author"><name><surname>Quinn</surname><given-names>N. P.</given-names></name><xref rid="AFF9">9</xref></contrib><contrib contrib-type="author"><name><surname>Speelman</surname><given-names>J. D.</given-names></name><xref rid="AFF10">10</xref></contrib><contrib contrib-type="author"><name><surname>Guridi</surname><given-names>J.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Zamarbide</surname><given-names>I.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Gironell</surname><given-names>A.</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author"><name><surname>Molet</surname><given-names>J.</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author"><name><surname>Pascual-Sedano</surname><given-names>B.</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author"><name><surname>Pidoux</surname><given-names>B.</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author"><name><surname>Bonnet</surname><given-names>A. M.</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author"><name><surname>Agid</surname><given-names>Y.</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author"><name><surname>Xie</surname><given-names>J.</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Benabid</surname><given-names>A.-L.</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Lozano</surname><given-names>A. M.</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Saint-Cyr</surname><given-names>J.</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Romito</surname><given-names>L.</given-names></name><xref rid="AFF7">7</xref></contrib><contrib contrib-type="author"><name><surname>Contarino</surname><given-names>M. F.</given-names></name><xref rid="AFF11">11</xref></contrib><contrib contrib-type="author"><name><surname>Scerrati</surname><given-names>M.</given-names></name><xref rid="AFF7">7</xref></contrib><contrib contrib-type="author"><name><surname>Fraix</surname><given-names>V.</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Van Blercom</surname><given-names>N.</given-names></name><xref rid="AFF4">4</xref></contrib><aff><target target-type="aff" id="AFF1"></target><label>1</label>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain, <target target-type="aff" id="AFF2"></target><label>2</label>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada, <target target-type="aff" id="AFF3"></target><label>3</label>Groupe Hospitalier Pitié-Salpetrière, Paris, <target target-type="aff" id="AFF4"></target><label>4</label>Service de Neurologie, University Hospital of Grenoble, France, <target target-type="aff" id="AFF5"></target><label>5</label>Neurosurgery Service, Lund University Hospital, Sweden, <target target-type="aff" id="AFF6"></target><label>6</label>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain, <target target-type="aff" id="AFF7"></target><label>7</label>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy, <target target-type="aff" id="AFF8"></target><label>8</label>Neurologische Klinik der Christian-Albrecht-Universität, Kiel, Germany, <target target-type="aff" id="AFF9"></target><label>9</label>Institute of Neurology, Queen Square, London, UK, <target target-type="aff" id="AFF10"></target><label>10</label>Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands and <target target-type="aff" id="AFF11"></target><label>11</label>Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome, Italy</aff></contrib-group><author-notes><corresp>Correspondence to: Prof J. A. Obeso, Neurologia-Neurociencias, Clinica Universitaria, Facultad de Medicina, Avenida de Pio XII, 36, Pamplona, 31008, Spain E-mail: <ext-link xlink:href="jobeso@unav.es" ext-link-type="email">jobeso@unav.es</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>October</month><year>2005</year></pub-date><pub-date pub-type="epub"><day>23</day><month>6</month><year>2005</year></pub-date><volume>128</volume><issue>10</issue><fpage>2240</fpage><lpage>2249</lpage><history><date date-type="accepted"><day>19</day><month>5</month><year>2005</year></date><date date-type="received"><day>4</day><month>2</month><year>2005</year></date><date date-type="rev-recd"><day>13</day><month>5</month><year>2005</year></date></history><copyright-statement>© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2005</copyright-year><abstract xml:lang="en"><p>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, <italic>n</italic> = 49) or globus pallidus internus (GPi, <italic>n</italic> = 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%; <italic>P</italic> < 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) (<italic>P</italic> < 0.0001 and <italic>P</italic> < 0.02 for STN and GPi, respectively) and prolonged the ‘on’ time spent with good mobility without dyskinesias (<italic>P</italic> < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (<italic>P</italic> < 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.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>deep brain stimulation</kwd><kwd>globus pallidus pars interna</kwd><kwd>long-term effects</kwd><kwd>Parkinson's disease</kwd><kwd>subthalamic nucleus</kwd></kwd-group><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>ADL = activities of daily living</kwd><kwd>AEs = adverse events</kwd><kwd>DBS = deep brain stimulation</kwd><kwd>GPi = globus pallidus pars interna</kwd><kwd>STN = subthalamic nucleus</kwd><kwd>UPDRS = Unified Parkinson's Disease Rating Scale</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>2240</meta-value></custom-meta><custom-meta><meta-name>cover-date</meta-name><meta-value>October 2005</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Original Article</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up</title></titleInfo><name type="personal"><namePart type="given">M. C.</namePart><namePart type="family">Rodriguez-Oroz</namePart><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J. A.</namePart><namePart type="family">Obeso</namePart><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A. E.</namePart><namePart type="family">Lang</namePart><affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.-L.</namePart><namePart type="family">Houeto</namePart><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Pollak</namePart><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.</namePart><namePart type="family">Rehncrona</namePart><affiliation>Neurosurgery Service, Lund University Hospital, Sweden,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Kulisevsky</namePart><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Albanese</namePart><affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Volkmann</namePart><affiliation>Neurologische Klinik der Christian-Albrecht-Universität, Kiel, Germany,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M. I.</namePart><namePart type="family">Hariz</namePart><affiliation>Institute of Neurology, Queen Square, London, UK,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N. P.</namePart><namePart type="family">Quinn</namePart><affiliation>Institute of Neurology, Queen Square, London, UK,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J. D.</namePart><namePart type="family">Speelman</namePart><affiliation>Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands and</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Guridi</namePart><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I.</namePart><namePart type="family">Zamarbide</namePart><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Gironell</namePart><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Molet</namePart><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B.</namePart><namePart type="family">Pascual-Sedano</namePart><affiliation>Department of Neurology, Hospital de Sant Pau, Barcelona, Spain,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B.</namePart><namePart type="family">Pidoux</namePart><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A. M.</namePart><namePart type="family">Bonnet</namePart><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Y.</namePart><namePart type="family">Agid</namePart><affiliation>Groupe Hospitalier Pitié-Salpetrière, Paris,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Xie</namePart><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.-L.</namePart><namePart type="family">Benabid</namePart><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A. M.</namePart><namePart type="family">Lozano</namePart><affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Saint-Cyr</namePart><affiliation>Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L.</namePart><namePart type="family">Romito</namePart><affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M. F.</namePart><namePart type="family">Contarino</namePart><affiliation>Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome, Italy</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Scerrati</namePart><affiliation>Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">V.</namePart><namePart type="family">Fraix</namePart><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N.</namePart><namePart type="family">Van Blercom</namePart><affiliation>Service de Neurologie, University Hospital of Grenoble, France,</affiliation><affiliation>Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2005-10</dateIssued><dateCreated encoding="w3cdtf">2005-06-23</dateCreated><copyrightDate encoding="w3cdtf">2005</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract 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.</abstract><note type="author-notes">Correspondence to: Prof J. A. Obeso, Neurologia-Neurociencias, Clinica Universitaria, Facultad de Medicina, Avenida de Pio XII, 36, Pamplona, 31008, Spain E-mail: jobeso@unav.es</note><subject lang="en"><genre>KWD</genre><topic>deep brain stimulation</topic><topic>globus pallidus pars interna</topic><topic>long-term effects</topic><topic>Parkinson's disease</topic><topic>subthalamic nucleus</topic></subject><subject lang="en"><genre>ABR</genre><topic>ADL = activities of daily living</topic><topic>AEs = adverse events</topic><topic>DBS = deep brain stimulation</topic><topic>GPi = globus pallidus pars interna</topic><topic>STN = subthalamic nucleus</topic><topic>UPDRS = Unified Parkinson's Disease Rating Scale</topic></subject><relatedItem type="host"><titleInfo><title>Brain</title></titleInfo><titleInfo type="abbreviated"><title>Brain</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0006-8950</identifier><identifier type="eISSN">1460-2156</identifier><identifier type="PublisherID">brainj</identifier><identifier type="PublisherID-hwp">brain</identifier><identifier type="PublisherID-nlm-ta">Brain</identifier><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>128</number></detail><detail type="issue"><caption>no.</caption><number>10</number></detail><extent unit="pages"><start>2240</start><end>2249</end></extent></part></relatedItem><identifier type="istex">860820614185D44B4C30C80E241B21643A5636C0</identifier><identifier type="DOI">10.1093/brain/awh571</identifier><identifier type="local">awh571</identifier><accessCondition type="use and reproduction" contentType="copyright">© The Author (2005). 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