Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation
Identifieur interne : 000C67 ( PascalFrancis/Checkpoint ); précédent : 000C66; suivant : 000C68Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation
Auteurs : R. Kumar [Canada] ; A. M. Lozano [Canada] ; E. Sime [Canada] ; E. Halket [Canada] ; A. E. Lang [Canada]Source :
- Neurology [ 0028-3878 ] ; 1999.
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- Pascal (Inist)
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- topic : Homme.
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Abstract
Article abstract-Objective: To compare the effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) with bilateral STN DBS in advanced PD. Methods: Our initial 10 consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic bilateral STN DBS underwent a standardized evaluation of unilateral and bilateral STN DBS in the medication-off state 6 to 18 months after electrode implantation. Results: Bilateral STN DBS improved the mean total Unified Parkinson's Disease Rating Scale motor score by 54%, whereas unilateral stimulation improved motor scores only 23%. Unilateral STN DBS improved postural stability and gait 14%, other axial motor features 19%, and overall parkinsonism in limbs contralateral to stimulation by 46%, including an 86% improvement in contralateral tremor. However, bilateral STN DBS resulted in greater improvement in each of these domains, including limb function, i.e., the reduction in scores from the limbs on one side was greater with bilateral than with unilateral stimulation of the contralateral STN. Conclusions: Bilateral STN DBS improves parkinsonism considerably more than unilateral STN DBS; bilateral simultaneous electrode implantation may be the most appropriate surgical option for patients with significant bilateral disability. Unilateral STN DBS results in moderate improvement in all aspects of off-period parkinsonism and improves tremor as much as is typically reported with DBS of the ventral intermedius nucleus of the thalamus (Vim). For this reason, STN DBS may be a more appropriate choice than Vim DBS or thalamotomy for parkinsonian tremor. Some patients with highly asymmetric tremor-dominant PD might be appropriately treated with unilateral instead of bilateral STN DBS.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation</title><author><name sortKey="Kumar, R" sort="Kumar, R" uniqKey="Kumar R" first="R." last="Kumar">R. Kumar</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></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 wicri:level="4"><inist:fA14 i1="02"><s1>Division of Neurosurgery, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Sime, E" sort="Sime, E" uniqKey="Sime E" first="E." last="Sime">E. Sime</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Halket, E" sort="Halket, E" uniqKey="Halket E" first="E." last="Halket">E. Halket</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></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 wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">99-0406941</idno><date when="1999">1999</date><idno type="stanalyst">PASCAL 99-0406941 INIST</idno><idno type="RBID">Pascal:99-0406941</idno><idno type="wicri:Area/PascalFrancis/Corpus">000D53</idno><idno type="wicri:Area/PascalFrancis/Curation">001170</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000C67</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000C67</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation</title><author><name sortKey="Kumar, R" sort="Kumar, R" uniqKey="Kumar R" first="R." last="Kumar">R. Kumar</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></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 wicri:level="4"><inist:fA14 i1="02"><s1>Division of Neurosurgery, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Sime, E" sort="Sime, E" uniqKey="Sime E" first="E." last="Sime">E. Sime</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Halket, E" sort="Halket, E" uniqKey="Halket E" first="E." last="Halket">E. Halket</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></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 wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></analytic><series><title level="j" type="main">Neurology</title><title level="j" type="abbreviated">Neurology</title><idno type="ISSN">0028-3878</idno><imprint><date when="1999">1999</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Neurology</title><title level="j" type="abbreviated">Neurology</title><idno type="ISSN">0028-3878</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bilateral</term><term>Comparative study</term><term>Human</term><term>Instrumental stimulation</term><term>Parkinson disease</term><term>Subthalamic nucleus</term><term>Treatment</term><term>Unilateral</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Stimulation instrumentale</term><term>Noyau sousthalamique</term><term>Etude comparative</term><term>Traitement</term><term>Homme</term><term>Unilatéral</term><term>Bilatéral</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Article abstract-Objective: To compare the effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) with bilateral STN DBS in advanced PD. Methods: Our initial 10 consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic bilateral STN DBS underwent a standardized evaluation of unilateral and bilateral STN DBS in the medication-off state 6 to 18 months after electrode implantation. Results: Bilateral STN DBS improved the mean total Unified Parkinson's Disease Rating Scale motor score by 54%, whereas unilateral stimulation improved motor scores only 23%. Unilateral STN DBS improved postural stability and gait 14%, other axial motor features 19%, and overall parkinsonism in limbs contralateral to stimulation by 46%, including an 86% improvement in contralateral tremor. However, bilateral STN DBS resulted in greater improvement in each of these domains, including limb function, i.e., the reduction in scores from the limbs on one side was greater with bilateral than with unilateral stimulation of the contralateral STN. Conclusions: Bilateral STN DBS improves parkinsonism considerably more than unilateral STN DBS; bilateral simultaneous electrode implantation may be the most appropriate surgical option for patients with significant bilateral disability. Unilateral STN DBS results in moderate improvement in all aspects of off-period parkinsonism and improves tremor as much as is typically reported with DBS of the ventral intermedius nucleus of the thalamus (Vim). For this reason, STN DBS may be a more appropriate choice than Vim DBS or thalamotomy for parkinsonian tremor. Some patients with highly asymmetric tremor-dominant PD might be appropriately treated with unilateral instead of bilateral STN DBS.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0028-3878</s0></fA01><fA02 i1="01"><s0>NEURAI</s0></fA02><fA03 i2="1"><s0>Neurology</s0></fA03><fA05><s2>53</s2></fA05><fA06><s2>3</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation</s1></fA08><fA11 i1="01" i2="1"><s1>KUMAR (R.)</s1></fA11><fA11 i1="02" i2="1"><s1>LOZANO (A. M.)</s1></fA11><fA11 i1="03" i2="1"><s1>SIME (E.)</s1></fA11><fA11 i1="04" i2="1"><s1>HALKET (E.)</s1></fA11><fA11 i1="05" i2="1"><s1>LANG (A. E.)</s1></fA11><fA14 i1="01"><s1>Division of Neurology, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></fA14><fA14 i1="02"><s1>Division of Neurosurgery, Faculty of Medicine, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ></fA14><fA20><s1>561-566</s1></fA20><fA21><s1>1999</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>6345</s2><s5>354000089406380210</s5></fA43><fA44><s0>0000</s0><s1>© 1999 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>27 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>99-0406941</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Neurology</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>Article abstract-Objective: To compare the effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) with bilateral STN DBS in advanced PD. Methods: Our initial 10 consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic bilateral STN DBS underwent a standardized evaluation of unilateral and bilateral STN DBS in the medication-off state 6 to 18 months after electrode implantation. Results: Bilateral STN DBS improved the mean total Unified Parkinson's Disease Rating Scale motor score by 54%, whereas unilateral stimulation improved motor scores only 23%. Unilateral STN DBS improved postural stability and gait 14%, other axial motor features 19%, and overall parkinsonism in limbs contralateral to stimulation by 46%, including an 86% improvement in contralateral tremor. However, bilateral STN DBS resulted in greater improvement in each of these domains, including limb function, i.e., the reduction in scores from the limbs on one side was greater with bilateral than with unilateral stimulation of the contralateral STN. Conclusions: Bilateral STN DBS improves parkinsonism considerably more than unilateral STN DBS; bilateral simultaneous electrode implantation may be the most appropriate surgical option for patients with significant bilateral disability. Unilateral STN DBS results in moderate improvement in all aspects of off-period parkinsonism and improves tremor as much as is typically reported with DBS of the ventral intermedius nucleus of the thalamus (Vim). For this reason, STN DBS may be a more appropriate choice than Vim DBS or thalamotomy for parkinsonian tremor. Some patients with highly asymmetric tremor-dominant PD might be appropriately treated with unilateral instead of bilateral STN DBS.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Parkinson maladie</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Parkinson disease</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Stimulation instrumentale</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Instrumental stimulation</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Estimulación instrumental</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Noyau sousthalamique</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Subthalamic nucleus</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Núcleo subtalámico</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Etude comparative</s0><s5>16</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Comparative study</s0><s5>16</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Estudio comparativo</s0><s5>16</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Traitement</s0><s5>17</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Treatment</s0><s5>17</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Tratamiento</s0><s5>17</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Homme</s0><s5>20</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Human</s0><s5>20</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Hombre</s0><s5>20</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Unilatéral</s0><s5>23</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Unilateral</s0><s5>23</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Unilateral</s0><s5>23</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Bilatéral</s0><s5>24</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Bilateral</s0><s5>24</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Bilateral</s0><s5>24</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Traitement instrumental</s0><s5>45</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Instrumentation therapy</s0><s5>45</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Tratamiento instrumental</s0><s5>45</s5></fC07><fN21><s1>263</s1></fN21></pA></standard></inist><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><country name="Canada"><region name="Ontario"><name sortKey="Kumar, R" sort="Kumar, R" uniqKey="Kumar R" first="R." last="Kumar">R. Kumar</name></region><name sortKey="Halket, E" sort="Halket, E" uniqKey="Halket E" first="E." last="Halket">E. Halket</name><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><name sortKey="Sime, E" sort="Sime, E" uniqKey="Sime E" first="E." last="Sime">E. Sime</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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