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Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.

Identifieur interne : 001418 ( PubMed/Corpus ); précédent : 001417; suivant : 001419

Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.

Auteurs : Galit Kleiner-Fisman ; David N. Fisman ; Elspeth Sime ; Jean A. Saint-Cyr ; Andres M. Lozano ; Anthony E. Lang

Source :

Journal of neurosurgery [ 0022-3085 ] ; 2003.

RBID : pubmed:12959435

English descriptors

KwdEn :
- Adult, Aged, Cohort Studies, Electric Stimulation Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Parkinson Disease (therapy), Subthalamic Nucleus (physiopathology).
MESH :
- physiopathology : Subthalamic Nucleus.
- therapy : Parkinson Disease.
- Adult, Aged, Cohort Studies, Electric Stimulation Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged.

Abstract

The use of deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been associated with a marked initial improvement in individuals with advanced Parkinson disease (PD). Few data are available on the long-term outcomes of this procedure, however, or whether the initial benefits are sustained over time. The authors present the long-term results of a cohort of 25 individuals who underwent bilateral DBS of the STN between 1996 and 2001 and were followed up for 1 year or longer after implantation of the stimulator.

DOI: 10.3171/jns.2003.99.3.0489
PubMed: 12959435

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pubmed:12959435

Le document en format XML

<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.</title>
<author><name sortKey="Kleiner Fisman, Galit" sort="Kleiner Fisman, Galit" uniqKey="Kleiner Fisman G" first="Galit" last="Kleiner-Fisman">Galit Kleiner-Fisman</name>
<affiliation><nlm:affiliation>Division of Neurology and Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Fisman, David N" sort="Fisman, David N" uniqKey="Fisman D" first="David N" last="Fisman">David N. Fisman</name>
</author>
<author><name sortKey="Sime, Elspeth" sort="Sime, Elspeth" uniqKey="Sime E" first="Elspeth" last="Sime">Elspeth Sime</name>
</author>
<author><name sortKey="Saint Cyr, Jean A" sort="Saint Cyr, Jean A" uniqKey="Saint Cyr J" first="Jean A" last="Saint-Cyr">Jean A. Saint-Cyr</name>
</author>
<author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M" last="Lozano">Andres M. Lozano</name>
</author>
<author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E" last="Lang">Anthony E. Lang</name>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PubMed</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.</title>
<author><name sortKey="Kleiner Fisman, Galit" sort="Kleiner Fisman, Galit" uniqKey="Kleiner Fisman G" first="Galit" last="Kleiner-Fisman">Galit Kleiner-Fisman</name>
<affiliation><nlm:affiliation>Division of Neurology and Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Fisman, David N" sort="Fisman, David N" uniqKey="Fisman D" first="David N" last="Fisman">David N. Fisman</name>
</author>
<author><name sortKey="Sime, Elspeth" sort="Sime, Elspeth" uniqKey="Sime E" first="Elspeth" last="Sime">Elspeth Sime</name>
</author>
<author><name sortKey="Saint Cyr, Jean A" sort="Saint Cyr, Jean A" uniqKey="Saint Cyr J" first="Jean A" last="Saint-Cyr">Jean A. Saint-Cyr</name>
</author>
<author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M" last="Lozano">Andres M. Lozano</name>
</author>
<author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E" last="Lang">Anthony E. Lang</name>
</author>
</analytic>
<series><title level="j">Journal of neurosurgery</title>
<idno type="ISSN">0022-3085</idno>
<imprint><date when="2003" type="published">2003</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Cohort Studies</term>
<term>Electric Stimulation Therapy</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Parkinson Disease (therapy)</term>
<term>Subthalamic Nucleus (physiopathology)</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Subthalamic Nucleus</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Cohort Studies</term>
<term>Electric Stimulation Therapy</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
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<front><div type="abstract" xml:lang="en">The use of deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been associated with a marked initial improvement in individuals with advanced Parkinson disease (PD). Few data are available on the long-term outcomes of this procedure, however, or whether the initial benefits are sustained over time. The authors present the long-term results of a cohort of 25 individuals who underwent bilateral DBS of the STN between 1996 and 2001 and were followed up for 1 year or longer after implantation of the stimulator.</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">12959435</PMID>
<DateCreated><Year>2003</Year>
<Month>09</Month>
<Day>08</Day>
</DateCreated>
<DateCompleted><Year>2003</Year>
<Month>09</Month>
<Day>30</Day>
</DateCompleted>
<DateRevised><Year>2006</Year>
<Month>11</Month>
<Day>15</Day>
</DateRevised>
<Article PubModel="Print"><Journal><ISSN IssnType="Print">0022-3085</ISSN>
<JournalIssue CitedMedium="Print"><Volume>99</Volume>
<Issue>3</Issue>
<PubDate><Year>2003</Year>
<Month>Sep</Month>
</PubDate>
</JournalIssue>
<Title>Journal of neurosurgery</Title>
<ISOAbbreviation>J. Neurosurg.</ISOAbbreviation>
</Journal>
<ArticleTitle>Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.</ArticleTitle>
<Pagination><MedlinePgn>489-95</MedlinePgn>
</Pagination>
<Abstract><AbstractText Label="OBJECT" NlmCategory="OBJECTIVE">The use of deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been associated with a marked initial improvement in individuals with advanced Parkinson disease (PD). Few data are available on the long-term outcomes of this procedure, however, or whether the initial benefits are sustained over time. The authors present the long-term results of a cohort of 25 individuals who underwent bilateral DBS of the STN between 1996 and 2001 and were followed up for 1 year or longer after implantation of the stimulator.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">Patients were evaluated at baseline and repeatedly after surgery by using the Unified Parkinson's Disease Rating Scale (UPDRS); the scale was applied to patients during periods in which antiparkinsonian medications were effective and periods when their effects had worn off. Postoperative UPDRS total scores and subscores, dyskinesia scores, and drug dosages were compared with baseline values, and changes in the patients' postoperative scores were evaluated to assess the possibility that the effect of DBS diminished over time. In this cohort the median duration of follow-up review was 24 months (range 12-52 months). The combined (ADL and motor) total UPDRS score during the medication-off period improved after 1 year, decreasing by 42% relative to baseline (95% confidence interval [CI 35-50%], p < 0.001) and the motor score decreased by 48% (95% CI 42-55%, p < 0.001). These gains did diminish over time, although a sustained clinical benefit remained at the time of the last evaluation (41% improvement over baseline, 95% CI 31-50%; p < 0.001). Axial subscores at the time of the last evaluation showed only a trend toward improvement (p = 0.08), in contrast to scores for total tremor (p < 0.001), rigidity (p < 0.001), and bradykinesia (p = 0.003), for which highly significant differences from baseline were still present at the time of the last evaluation. Medication requirements diminished substantially, with total medication doses reduced by 38% (95% CI 27-48%, p < 0.001) at 1 year and 36% (95% CI 25-48%, p < 0.001) at the time of the last evaluation; this decrease may have accounted, at least in part, for the significant decrease of 46.4% (95% CI 20.2-72.5%, p = 0.007) in dyskinesia scores obtained by patients during the medication-on period. No preoperative demographic variable, such as the patient's age at the time of disease onset, age at surgery, sex, duration of disease before surgery, preoperative drug dosage, or preoperative severity of dyskinesia, was predictive of long-term outcome. The only predictor of a better outcome was the patient's preoperative response to levodopa.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">In this group of patients with advanced PD who underwent bilateral DBS of the STN, sustained improvement in motor function was present a mean of 2 years after the procedure, and sustained reductions in drug requirements were also achieved. Improvements in tremor, rigidity, and bradykinesia were more marked and better sustained over time than improvements in axial symptoms. A good preoperative response to levodopa predicted a good response to surgery.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kleiner-Fisman</LastName>
<ForeName>Galit</ForeName>
<Initials>G</Initials>
<AffiliationInfo><Affiliation>Division of Neurology and Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Fisman</LastName>
<ForeName>David N</ForeName>
<Initials>DN</Initials>
</Author>
<Author ValidYN="Y"><LastName>Sime</LastName>
<ForeName>Elspeth</ForeName>
<Initials>E</Initials>
</Author>
<Author ValidYN="Y"><LastName>Saint-Cyr</LastName>
<ForeName>Jean A</ForeName>
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</Author>
<Author ValidYN="Y"><LastName>Lozano</LastName>
<ForeName>Andres M</ForeName>
<Initials>AM</Initials>
</Author>
<Author ValidYN="Y"><LastName>Lang</LastName>
<ForeName>Anthony E</ForeName>
<Initials>AE</Initials>
</Author>
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<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType>
</PublicationTypeList>
</Article>
<MedlineJournalInfo><Country>United States</Country>
<MedlineTA>J Neurosurg</MedlineTA>
<NlmUniqueID>0253357</NlmUniqueID>
<ISSNLinking>0022-3085</ISSNLinking>
</MedlineJournalInfo>
<CitationSubset>AIM</CitationSubset>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D004599" MajorTopicYN="Y">Electric Stimulation Therapy</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005500" MajorTopicYN="N">Follow-Up Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D010300" MajorTopicYN="N">Parkinson Disease</DescriptorName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D020531" MajorTopicYN="N">Subthalamic Nucleus</DescriptorName>
<QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName>
</MeshHeading>
</MeshHeadingList>
</MedlineCitation>
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Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.

Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.

Source :

English descriptors

Abstract

Links to Exploration step

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri

Pour générer des pages wiki