Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease.
Identifieur interne : 002A96 ( Ncbi/Checkpoint ); précédent : 002A95; suivant : 002A97Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease.
Auteurs : Elena Moro [Canada] ; Andres M. Lozano ; Pierre Pollak ; Yves Agid [France] ; Stig Rehncrona ; Jens Volkmann ; Jaime Kulisevsky ; Jose A. Obeso ; Alberto Albanese ; Marwan I. Hariz ; Niall P. Quinn ; Jans D. Speelman ; Alim L. Benabid ; Valerie Fraix ; Alexandre Mendes ; Marie-Laure Welter ; Jean-Luc Houeto ; Philippe Cornu ; Didier Dormont ; Annalena L. Tornqvist ; Ron Ekberg ; Alfons Schnitzler ; Lars Timmermann ; Lars Wojtecki ; Andres Gironell ; Maria C. Rodriguez-Oroz ; Jorge Guridi ; Anna R. Bentivoglio ; Maria F. Contarino ; Luigi Romito ; Massimo Scerrati ; Marc Janssens ; Anthony E. LangSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2010.
English descriptors
- KwdEn :
- MESH :
- physiology : Globus Pallidus, Subthalamus.
- therapy : Parkinson Disease.
- Aged, Cross-Over Studies, Deep Brain Stimulation, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Severity of Illness Index, Time Factors, Treatment Outcome.
Abstract
We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-five STN patients and 16 GPi patients were assessed at 5 to 6 years after DBS surgery. Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN, P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with off-stimulation, regardless of the sequence of stimulation. In open assessment, both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN, P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group. These results confirm the long-term efficacy of STN and GPi DBS in advanced PD. Although the surgical targets were not randomized, there was a trend to a better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group.
DOI: 10.1002/mds.22735
PubMed: 20213817
Affiliations:
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease.</title>
<author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name>
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<author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name>
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<author><name sortKey="Agid, Yves" sort="Agid, Yves" uniqKey="Agid Y" first="Yves" last="Agid">Yves Agid</name>
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<author><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name>
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<author><name sortKey="Kulisevsky, Jaime" sort="Kulisevsky, Jaime" uniqKey="Kulisevsky J" first="Jaime" last="Kulisevsky">Jaime Kulisevsky</name>
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<author><name sortKey="Obeso, Jose A" sort="Obeso, Jose A" uniqKey="Obeso J" first="Jose A" last="Obeso">Jose A. Obeso</name>
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<author><name sortKey="Albanese, Alberto" sort="Albanese, Alberto" uniqKey="Albanese A" first="Alberto" last="Albanese">Alberto Albanese</name>
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<author><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I" last="Hariz">Marwan I. Hariz</name>
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<author><name sortKey="Quinn, Niall P" sort="Quinn, Niall P" uniqKey="Quinn N" first="Niall P" last="Quinn">Niall P. Quinn</name>
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<author><name sortKey="Speelman, Jans D" sort="Speelman, Jans D" uniqKey="Speelman J" first="Jans D" last="Speelman">Jans D. Speelman</name>
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<author><name sortKey="Benabid, Alim L" sort="Benabid, Alim L" uniqKey="Benabid A" first="Alim L" last="Benabid">Alim L. Benabid</name>
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<author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valerie" last="Fraix">Valerie Fraix</name>
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<author><name sortKey="Mendes, Alexandre" sort="Mendes, Alexandre" uniqKey="Mendes A" first="Alexandre" last="Mendes">Alexandre Mendes</name>
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<author><name sortKey="Welter, Marie Laure" sort="Welter, Marie Laure" uniqKey="Welter M" first="Marie-Laure" last="Welter">Marie-Laure Welter</name>
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<author><name sortKey="Houeto, Jean Luc" sort="Houeto, Jean Luc" uniqKey="Houeto J" first="Jean-Luc" last="Houeto">Jean-Luc Houeto</name>
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<author><name sortKey="Cornu, Philippe" sort="Cornu, Philippe" uniqKey="Cornu P" first="Philippe" last="Cornu">Philippe Cornu</name>
</author>
<author><name sortKey="Dormont, Didier" sort="Dormont, Didier" uniqKey="Dormont D" first="Didier" last="Dormont">Didier Dormont</name>
</author>
<author><name sortKey="Tornqvist, Annalena L" sort="Tornqvist, Annalena L" uniqKey="Tornqvist A" first="Annalena L" last="Tornqvist">Annalena L. Tornqvist</name>
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<author><name sortKey="Ekberg, Ron" sort="Ekberg, Ron" uniqKey="Ekberg R" first="Ron" last="Ekberg">Ron Ekberg</name>
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<author><name sortKey="Schnitzler, Alfons" sort="Schnitzler, Alfons" uniqKey="Schnitzler A" first="Alfons" last="Schnitzler">Alfons Schnitzler</name>
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<author><name sortKey="Timmermann, Lars" sort="Timmermann, Lars" uniqKey="Timmermann L" first="Lars" last="Timmermann">Lars Timmermann</name>
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<author><name sortKey="Wojtecki, Lars" sort="Wojtecki, Lars" uniqKey="Wojtecki L" first="Lars" last="Wojtecki">Lars Wojtecki</name>
</author>
<author><name sortKey="Gironell, Andres" sort="Gironell, Andres" uniqKey="Gironell A" first="Andres" last="Gironell">Andres Gironell</name>
</author>
<author><name sortKey="Rodriguez Oroz, Maria C" sort="Rodriguez Oroz, Maria C" uniqKey="Rodriguez Oroz M" first="Maria C" last="Rodriguez-Oroz">Maria C. Rodriguez-Oroz</name>
</author>
<author><name sortKey="Guridi, Jorge" sort="Guridi, Jorge" uniqKey="Guridi J" first="Jorge" last="Guridi">Jorge Guridi</name>
</author>
<author><name sortKey="Bentivoglio, Anna R" sort="Bentivoglio, Anna R" uniqKey="Bentivoglio A" first="Anna R" last="Bentivoglio">Anna R. Bentivoglio</name>
</author>
<author><name sortKey="Contarino, Maria F" sort="Contarino, Maria F" uniqKey="Contarino M" first="Maria F" last="Contarino">Maria F. Contarino</name>
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<author><name sortKey="Romito, Luigi" sort="Romito, Luigi" uniqKey="Romito L" first="Luigi" last="Romito">Luigi Romito</name>
</author>
<author><name sortKey="Scerrati, Massimo" sort="Scerrati, Massimo" uniqKey="Scerrati M" first="Massimo" last="Scerrati">Massimo Scerrati</name>
</author>
<author><name sortKey="Janssens, Marc" sort="Janssens, Marc" uniqKey="Janssens M" first="Marc" last="Janssens">Marc Janssens</name>
</author>
<author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E" last="Lang">Anthony E. Lang</name>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Cross-Over Studies</term>
<term>Deep Brain Stimulation</term>
<term>Double-Blind Method</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Globus Pallidus (physiology)</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Parkinson Disease (therapy)</term>
<term>Severity of Illness Index</term>
<term>Subthalamus (physiology)</term>
<term>Time Factors</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Globus Pallidus</term>
<term>Subthalamus</term>
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<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Cross-Over Studies</term>
<term>Deep Brain Stimulation</term>
<term>Double-Blind Method</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Severity of Illness Index</term>
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<front><div type="abstract" xml:lang="en">We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-five STN patients and 16 GPi patients were assessed at 5 to 6 years after DBS surgery. Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN, P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with off-stimulation, regardless of the sequence of stimulation. In open assessment, both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN, P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group. These results confirm the long-term efficacy of STN and GPi DBS in advanced PD. Although the surgical targets were not randomized, there was a trend to a better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group.</div>
</front>
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<affiliations><list><country><li>Canada</li>
<li>France</li>
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<name sortKey="Bentivoglio, Anna R" sort="Bentivoglio, Anna R" uniqKey="Bentivoglio A" first="Anna R" last="Bentivoglio">Anna R. Bentivoglio</name>
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<name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M" last="Lozano">Andres M. Lozano</name>
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<name sortKey="Obeso, Jose A" sort="Obeso, Jose A" uniqKey="Obeso J" first="Jose A" last="Obeso">Jose A. Obeso</name>
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<name sortKey="Quinn, Niall P" sort="Quinn, Niall P" uniqKey="Quinn N" first="Niall P" last="Quinn">Niall P. Quinn</name>
<name sortKey="Rehncrona, Stig" sort="Rehncrona, Stig" uniqKey="Rehncrona S" first="Stig" last="Rehncrona">Stig Rehncrona</name>
<name sortKey="Rodriguez Oroz, Maria C" sort="Rodriguez Oroz, Maria C" uniqKey="Rodriguez Oroz M" first="Maria C" last="Rodriguez-Oroz">Maria C. Rodriguez-Oroz</name>
<name sortKey="Romito, Luigi" sort="Romito, Luigi" uniqKey="Romito L" first="Luigi" last="Romito">Luigi Romito</name>
<name sortKey="Scerrati, Massimo" sort="Scerrati, Massimo" uniqKey="Scerrati M" first="Massimo" last="Scerrati">Massimo Scerrati</name>
<name sortKey="Schnitzler, Alfons" sort="Schnitzler, Alfons" uniqKey="Schnitzler A" first="Alfons" last="Schnitzler">Alfons Schnitzler</name>
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