Subthalamic stimulation in Parkinson disease : A multidisciplinary approach
Identifieur interne : 001180 ( PascalFrancis/Checkpoint ); précédent : 001179; suivant : 001181Subthalamic stimulation in Parkinson disease : A multidisciplinary approach
Auteurs : J. L. Houeto [France] ; P. Damier [France] ; P. B. Bejjani [France] ; C. Staedler [France] ; A. M. Bonnet [France] ; I. Arnulf [France] ; B. Pidoux [France] ; D. Dormont [France] ; P. Cornu [France] ; Yves Agid [France]Source :
- Archives of neurology : (Chicago) [ 0003-9942 ] ; 2000.
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- Pascal (Inist)
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- topic : Homme.
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Abstract
Background: High-frequency stimulation of the subthalamic nucleus constitutes a therapeutic advance for severely disabled patients with Parkinson disease. Objective: To evaluate the efficacy and safety of continuous bilateral high-frequency stimulation of the subthalamic nucleus in patients with Parkinson disease. Design: A prospective study of patients with Parkinson disease treated at a university hospital. Patients and Methods: Electrodes were implanted bilaterally in the subthalamic nucleus of 23 consecutive patients with Parkinson disease who responded well to levodopa but had severe motor complications. There were 16 men and 7 women (mean ± SEM age, 53 ± 2 years) who had a mean ± SEM disease duration of 14.7 ± 1.0 years. Targets were determined by 3-dimensional magnetic resonance imaging, combined with intraoperative electrophysiologic recordings and stimulation. Results: Six months after surgery, motor disability, levodopa-induced motor fluctuations, dyskinesias, and the daily dose of levodopa equivalent decreased significantly by 67%, 78%, 77%, and 61%, respectively, compared with the preoperative state. No significant morbidity was ohserved, except transient depression in 4 patients. Conclusions: The beneficial effects of subthalamic stimulation depend on (1) the criteria used for patient selection, (2) the precision with which the subthalamic nucleus is targeted (dependent on the 3-dimensional magnetic resonance imaging and the intraoperative electrophysiologic and clinical assessments), and (3) the long-term postoperative adjustment of stimulation variables.
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bilateral</term>
<term>Continuous</term>
<term>High frequency</term>
<term>Human</term>
<term>Instrumental stimulation</term>
<term>Parkinson disease</term>
<term>Performance evaluation</term>
<term>Subthalamic nucleus</term>
<term>Treatment</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term>
<term>Stimulation instrumentale</term>
<term>Haute fréquence</term>
<term>Noyau sousthalamique</term>
<term>Evaluation performance</term>
<term>Traitement</term>
<term>Homme</term>
<term>Bilatéral</term>
<term>Continu</term>
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<front><div type="abstract" xml:lang="en">Background: High-frequency stimulation of the subthalamic nucleus constitutes a therapeutic advance for severely disabled patients with Parkinson disease. Objective: To evaluate the efficacy and safety of continuous bilateral high-frequency stimulation of the subthalamic nucleus in patients with Parkinson disease. Design: A prospective study of patients with Parkinson disease treated at a university hospital. Patients and Methods: Electrodes were implanted bilaterally in the subthalamic nucleus of 23 consecutive patients with Parkinson disease who responded well to levodopa but had severe motor complications. There were 16 men and 7 women (mean ± SEM age, 53 ± 2 years) who had a mean ± SEM disease duration of 14.7 ± 1.0 years. Targets were determined by 3-dimensional magnetic resonance imaging, combined with intraoperative electrophysiologic recordings and stimulation. Results: Six months after surgery, motor disability, levodopa-induced motor fluctuations, dyskinesias, and the daily dose of levodopa equivalent decreased significantly by 67%, 78%, 77%, and 61%, respectively, compared with the preoperative state. No significant morbidity was ohserved, except transient depression in 4 patients. Conclusions: The beneficial effects of subthalamic stimulation depend on (1) the criteria used for patient selection, (2) the precision with which the subthalamic nucleus is targeted (dependent on the 3-dimensional magnetic resonance imaging and the intraoperative electrophysiologic and clinical assessments), and (3) the long-term postoperative adjustment of stimulation variables.</div>
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<fA11 i1="01" i2="1"><s1>HOUETO (J. L.)</s1>
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<fA11 i1="02" i2="1"><s1>DAMIER (P.)</s1>
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<fA11 i1="06" i2="1"><s1>ARNULF (I.)</s1>
</fA11>
<fA11 i1="07" i2="1"><s1>PIDOUX (B.)</s1>
</fA11>
<fA11 i1="08" i2="1"><s1>DORMONT (D.)</s1>
</fA11>
<fA11 i1="09" i2="1"><s1>CORNU (P.)</s1>
</fA11>
<fA11 i1="10" i2="1"><s1>AGID (Y.)</s1>
</fA11>
<fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologic and Institut National de la Santé et de la Recherche Médicale, Unit 289, Groupe Hospitalier Pitié-Salpêtrière</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>10 aut.</sZ>
</fA14>
<fA14 i1="02"><s1>Service d'Exploration Fonctionnelle Neurologique, Groupe Hospitalier Pitié-Salpêtrière</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>7 aut.</sZ>
</fA14>
<fA14 i1="03"><s1>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>8 aut.</sZ>
</fA14>
<fA14 i1="04"><s1>Service de Neurochirurgie, Groupe Hospitalier Pitic-Salpêtrière</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>9 aut.</sZ>
</fA14>
<fA20><s1>461-465</s1>
</fA20>
<fA21><s1>2000</s1>
</fA21>
<fA23 i1="01"><s0>ENG</s0>
</fA23>
<fA43 i1="01"><s1>INIST</s1>
<s2>2048B</s2>
<s5>354000082204290020</s5>
</fA43>
<fA44><s0>0000</s0>
<s1>© 2000 INIST-CNRS. All rights reserved.</s1>
</fA44>
<fA45><s0>16 ref.</s0>
</fA45>
<fA47 i1="01" i2="1"><s0>00-0226008</s0>
</fA47>
<fA60><s1>P</s1>
</fA60>
<fA61><s0>A</s0>
</fA61>
<fA64 i1="01" i2="1"><s0>Archives of neurology : (Chicago)</s0>
</fA64>
<fA66 i1="01"><s0>USA</s0>
</fA66>
<fC01 i1="01" l="ENG"><s0>Background: High-frequency stimulation of the subthalamic nucleus constitutes a therapeutic advance for severely disabled patients with Parkinson disease. Objective: To evaluate the efficacy and safety of continuous bilateral high-frequency stimulation of the subthalamic nucleus in patients with Parkinson disease. Design: A prospective study of patients with Parkinson disease treated at a university hospital. Patients and Methods: Electrodes were implanted bilaterally in the subthalamic nucleus of 23 consecutive patients with Parkinson disease who responded well to levodopa but had severe motor complications. There were 16 men and 7 women (mean ± SEM age, 53 ± 2 years) who had a mean ± SEM disease duration of 14.7 ± 1.0 years. Targets were determined by 3-dimensional magnetic resonance imaging, combined with intraoperative electrophysiologic recordings and stimulation. Results: Six months after surgery, motor disability, levodopa-induced motor fluctuations, dyskinesias, and the daily dose of levodopa equivalent decreased significantly by 67%, 78%, 77%, and 61%, respectively, compared with the preoperative state. No significant morbidity was ohserved, except transient depression in 4 patients. Conclusions: The beneficial effects of subthalamic stimulation depend on (1) the criteria used for patient selection, (2) the precision with which the subthalamic nucleus is targeted (dependent on the 3-dimensional magnetic resonance imaging and the intraoperative electrophysiologic and clinical assessments), and (3) the long-term postoperative adjustment of stimulation variables.</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>Haute fréquence</s0>
<s5>05</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>High frequency</s0>
<s5>05</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Alta frecuencia</s0>
<s5>05</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Noyau sousthalamique</s0>
<s5>07</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Subthalamic nucleus</s0>
<s5>07</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Núcleo subtalámico</s0>
<s5>07</s5>
</fC03>
<fC03 i1="05" i2="X" l="FRE"><s0>Evaluation performance</s0>
<s5>16</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG"><s0>Performance evaluation</s0>
<s5>16</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA"><s0>Evaluación prestación</s0>
<s5>16</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE"><s0>Traitement</s0>
<s5>17</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG"><s0>Treatment</s0>
<s5>17</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA"><s0>Tratamiento</s0>
<s5>17</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE"><s0>Homme</s0>
<s5>20</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG"><s0>Human</s0>
<s5>20</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA"><s0>Hombre</s0>
<s5>20</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE"><s0>Bilatéral</s0>
<s5>23</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG"><s0>Bilateral</s0>
<s5>23</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA"><s0>Bilateral</s0>
<s5>23</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE"><s0>Continu</s0>
<s5>24</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG"><s0>Continuous</s0>
<s5>24</s5>
</fC03>
<fC03 i1="09" i2="X" l="SPA"><s0>Contínuo</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>
<fC07 i1="07" i2="X" l="FRE"><s0>Encéphale</s0>
<s5>53</s5>
</fC07>
<fC07 i1="07" i2="X" l="ENG"><s0>Brain (vertebrata)</s0>
<s5>53</s5>
</fC07>
<fC07 i1="07" i2="X" l="SPA"><s0>Encéfalo</s0>
<s5>53</s5>
</fC07>
<fN21><s1>157</s1>
</fN21>
</pA>
</standard>
</inist>
<affiliations><list><country><li>France</li>
</country>
<region><li>Île-de-France</li>
</region>
<settlement><li>Paris</li>
</settlement>
<orgName><li>Hôpital de la Salpêtrière</li>
</orgName>
</list>
<tree><country name="France"><region name="Île-de-France"><name sortKey="Houeto, J L" sort="Houeto, J L" uniqKey="Houeto J" first="J. L." last="Houeto">J. L. Houeto</name>
</region>
<name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Yves Agid</name>
<name sortKey="Arnulf, I" sort="Arnulf, I" uniqKey="Arnulf I" first="I." last="Arnulf">I. Arnulf</name>
<name sortKey="Bejjani, P B" sort="Bejjani, P B" uniqKey="Bejjani P" first="P. B." last="Bejjani">P. B. Bejjani</name>
<name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A. M." last="Bonnet">A. M. Bonnet</name>
<name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P." last="Cornu">P. Cornu</name>
<name sortKey="Damier, P" sort="Damier, P" uniqKey="Damier P" first="P." last="Damier">P. Damier</name>
<name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D." last="Dormont">D. Dormont</name>
<name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B." last="Pidoux">B. Pidoux</name>
<name sortKey="Staedler, C" sort="Staedler, C" uniqKey="Staedler C" first="C." last="Staedler">C. Staedler</name>
</country>
</tree>
</affiliations>
</record>
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