Low-frequency subthalamic nucleus deep brain stimulation for axial symptoms in advanced Parkinson's disease.
Identifieur interne : 000D44 ( Main/Exploration ); précédent : 000D43; suivant : 000D45Low-frequency subthalamic nucleus deep brain stimulation for axial symptoms in advanced Parkinson's disease.
Auteurs : Christos Sidiropoulos [Canada] ; Richard Walsh ; Christopher Meaney ; Y Y Poon ; Melanie Fallis ; Elena MoroSource :
- Journal of neurology [ 1432-1459 ] ; 2013.
English descriptors
- KwdEn :
- MESH :
- complications : Parkinson Disease.
- methods : Deep Brain Stimulation.
- prevention & control : Accidental Falls, Gait Disorders, Neurologic.
- therapy : Parkinson Disease.
- Female, Humans, Male, Middle Aged, Subthalamic Nucleus.
Abstract
Axial symptoms such as freezing of gait and falls are common manifestations of advanced Parkinson's disease (PD) and are partially responsive to medical treatment. High-frequency (≥130 Hz) deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly efficacious in ameliorating appendicular symptoms in PD. However, it is typically less effective in improving axial symptomatology, especially in the long term. We have studied the effects of low-frequency stimulation (LFS) (≤80 Hz) for improving speech, gait and balance dysfunction in the largest patient population to date. PD patients with bilateral STN-DBS and resistant axial symptoms were switched from chronic 130 Hz stimulation to LFS and followed up to 4 years. Primary outcome measures were total motor UPDRS scores, and axial and gait subscores before and after LFS. Bivariate analyses and correlation coefficients were calculated for the different conditions. Potential predictors of therapeutic response were also investigated. Forty-five advanced PD patients who had high frequency stimulation (HFS) for 39.5 ± 27.8 consecutive months were switched to LFS. LFS was kept on for a median period of 111.5 days before the assessment. There was no significant improvement in any of the primary outcomes between HFS and LFS, although a minority of patients preferred to be maintained on LFS for longer periods of time. No predictive factors of response could be identified. There was overall no improvement from LFS in axial symptoms. This could be partly due to some study limitations. Larger prospective trials are warranted to better clarify the impact of stimulation frequency on axial signs.
DOI: 10.1007/s00415-013-6983-2
PubMed: 23749331
Affiliations:
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Walsh</name></author><author><name sortKey="Meaney, Christopher" sort="Meaney, Christopher" uniqKey="Meaney C" first="Christopher" last="Meaney">Christopher Meaney</name></author><author><name sortKey="Poon, Y Y" sort="Poon, Y Y" uniqKey="Poon Y" first="Y Y" last="Poon">Y Y Poon</name></author><author><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2013">2013</date><idno type="RBID">pubmed:23749331</idno><idno type="pmid">23749331</idno><idno type="doi">10.1007/s00415-013-6983-2</idno><idno type="wicri:Area/PubMed/Corpus">000869</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000869</idno><idno type="wicri:Area/PubMed/Curation">000869</idno><idno 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Toronto, UHN, Toronto, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Movement Disorders Centre, Toronto Western Hospital, University of Toronto, UHN, Toronto</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Walsh, Richard" sort="Walsh, Richard" uniqKey="Walsh R" first="Richard" last="Walsh">Richard Walsh</name></author><author><name sortKey="Meaney, Christopher" sort="Meaney, Christopher" uniqKey="Meaney C" first="Christopher" last="Meaney">Christopher Meaney</name></author><author><name sortKey="Poon, Y Y" sort="Poon, Y Y" uniqKey="Poon Y" first="Y Y" last="Poon">Y Y Poon</name></author><author><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></author></analytic><series><title level="j">Journal of neurology</title><idno type="eISSN">1432-1459</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Accidental Falls (prevention & control)</term><term>Deep Brain Stimulation (methods)</term><term>Female</term><term>Gait Disorders, Neurologic (prevention & control)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Parkinson Disease (complications)</term><term>Parkinson Disease (therapy)</term><term>Subthalamic Nucleus</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Accidental Falls</term><term>Gait Disorders, Neurologic</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Subthalamic Nucleus</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Axial symptoms such as freezing of gait and falls are common manifestations of advanced Parkinson's disease (PD) and are partially responsive to medical treatment. High-frequency (≥130 Hz) deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly efficacious in ameliorating appendicular symptoms in PD. However, it is typically less effective in improving axial symptomatology, especially in the long term. We have studied the effects of low-frequency stimulation (LFS) (≤80 Hz) for improving speech, gait and balance dysfunction in the largest patient population to date. PD patients with bilateral STN-DBS and resistant axial symptoms were switched from chronic 130 Hz stimulation to LFS and followed up to 4 years. Primary outcome measures were total motor UPDRS scores, and axial and gait subscores before and after LFS. Bivariate analyses and correlation coefficients were calculated for the different conditions. Potential predictors of therapeutic response were also investigated. Forty-five advanced PD patients who had high frequency stimulation (HFS) for 39.5 ± 27.8 consecutive months were switched to LFS. LFS was kept on for a median period of 111.5 days before the assessment. There was no significant improvement in any of the primary outcomes between HFS and LFS, although a minority of patients preferred to be maintained on LFS for longer periods of time. No predictive factors of response could be identified. There was overall no improvement from LFS in axial symptoms. This could be partly due to some study limitations. Larger prospective trials are warranted to better clarify the impact of stimulation frequency on axial signs.</div></front></TEI><affiliations><list><country><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><noCountry><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name><name sortKey="Meaney, Christopher" sort="Meaney, Christopher" uniqKey="Meaney C" first="Christopher" last="Meaney">Christopher Meaney</name><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><name sortKey="Poon, Y Y" sort="Poon, Y Y" uniqKey="Poon Y" first="Y Y" last="Poon">Y Y Poon</name><name sortKey="Walsh, Richard" sort="Walsh, Richard" uniqKey="Walsh R" first="Richard" last="Walsh">Richard Walsh</name></noCountry><country name="Canada"><region name="Ontario"><name sortKey="Sidiropoulos, Christos" sort="Sidiropoulos, Christos" uniqKey="Sidiropoulos C" first="Christos" last="Sidiropoulos">Christos Sidiropoulos</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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