ParkinsonFranceV1, PascalFrancis, Corpus, bibRecord, 001634

Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson disease

Identifieur interne : 001634 ( PascalFrancis/Corpus ); précédent : 001633; suivant : 001635

Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson disease

Auteurs : P. Krack ; P. Pollak ; P. Limousin ; D. Hoffmann ; J. Xie ; A. Benazzouz ; A. L. Benabid

Source :

Brain [ 0006-8950 ] ; 1998.

RBID : Pascal:98-0171789

Descripteurs français

Pascal (Inist)
- Parkinson maladie, Age apparition, Précoce, Stimulus électrique, Chronique, Bilatéral, Noyau sousthalamique, Pallidum, Interne, Effet on off, Traitement instrumental, Modalité traitement, Etude comparative, Adulte.

English descriptors

KwdEn :
- Adult, Age of onset, Application method, Bilateral, Chronic, Comparative study, Early, Electrical stimulus, Instrumentation therapy, Internal, On off effect, Pallidum, Parkinson disease, Subthalamic nucleus.

Abstract

The aim of this study was to compare, retrospectively, the value of chronic bilateral stimulation of the internal globus pallidus (GPi) and the subthalamic nucleus (STN) in patients with young onset Parkinson's disease. We selected 13 consecutive patients with similar characteristics at the time of surgery: age at onset <40 years, disabling motor fluctuations (Hoehn and Yahr stage 4 or 5 in off-drug phases) and levodopa-induced dyskinesias (LID). Eight patients were operated on in the STN and five in the GPi. The Unified Parkinson's Disease Rating Scale (UPDRS), timed motor tests and a LID scale were compared in on- and off-drug conditions before surgery and 6 months after surgery on stimulation using the chronic electrical parameters found to improve best the motor state of the individual patient, without adverse effects. In off-drug phases, the motor score of the UPDRS was improved by 71% with STN stimulation and by 39% with GPi stimulation on average. This difference was statistically significant (P < 0.05). Whereas rigidity and tremor showed good improvement in both groups, the decrease in the akinesia score was more pronounced in the STN group. In the STN group, the improvement of all motor symptoms was very close, or equal, to the best levodopa response. Thus the levodopa test was predictive ofoutcome. The improvement in off-drug period motor handicap allowed a decrease in the levodopa-equivalent dose only in the STN group (-56%). The voltage, frequency and pulse width used for chronic stimulation were lower in the STN group. In the on-drug phases there was a marked improvement in LID in the GPi group, as measured by the dyskinesias score during an acute levodopa test, whereas there was only a small decrease in the STN group (P < 0.05). However in the long term, the reduction of levodopa dosage in the STN group led to an indirect reduction of LID similar to that in the GPi group during activities of everyday life. In conclusion, the overall results favour the neurosurgical treatment of Parkinson's disease by stimulating the STN rather than the GPi.

Notice en format standard (ISO 2709)

Pour connaître la documentation sur le format Inist Standard.

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Format Inist (serveur)

NO :	PASCAL 98-0171789 INIST
ET :	Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson disease
AU :	KRACK (P.); POLLAK (P.); LIMOUSIN (P.); HOFFMANN (D.); XIE (J.); BENAZZOUZ (A.); BENABID (A. L.)
AF :	Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble/France (1 aut., 2 aut., 3 aut., 4 aut., 5 aut., 6 aut., 7 aut.)
DT :	Publication en série; Niveau analytique
SO :	Brain; ISSN 0006-8950; Royaume-Uni; Da. 1998; Vol. 121; No. p.3; Pp. 451-457; Bibl. 30 ref.
LA :	Anglais
EA :	The aim of this study was to compare, retrospectively, the value of chronic bilateral stimulation of the internal globus pallidus (GPi) and the subthalamic nucleus (STN) in patients with young onset Parkinson's disease. We selected 13 consecutive patients with similar characteristics at the time of surgery: age at onset <40 years, disabling motor fluctuations (Hoehn and Yahr stage 4 or 5 in off-drug phases) and levodopa-induced dyskinesias (LID). Eight patients were operated on in the STN and five in the GPi. The Unified Parkinson's Disease Rating Scale (UPDRS), timed motor tests and a LID scale were compared in on- and off-drug conditions before surgery and 6 months after surgery on stimulation using the chronic electrical parameters found to improve best the motor state of the individual patient, without adverse effects. In off-drug phases, the motor score of the UPDRS was improved by 71% with STN stimulation and by 39% with GPi stimulation on average. This difference was statistically significant (P < 0.05). Whereas rigidity and tremor showed good improvement in both groups, the decrease in the akinesia score was more pronounced in the STN group. In the STN group, the improvement of all motor symptoms was very close, or equal, to the best levodopa response. Thus the levodopa test was predictive ofoutcome. The improvement in off-drug period motor handicap allowed a decrease in the levodopa-equivalent dose only in the STN group (-56%). The voltage, frequency and pulse width used for chronic stimulation were lower in the STN group. In the on-drug phases there was a marked improvement in LID in the GPi group, as measured by the dyskinesias score during an acute levodopa test, whereas there was only a small decrease in the STN group (P < 0.05). However in the long term, the reduction of levodopa dosage in the STN group led to an indirect reduction of LID similar to that in the GPi group during activities of everyday life. In conclusion, the overall results favour the neurosurgical treatment of Parkinson's disease by stimulating the STN rather than the GPi.
CC :	002B26I
FD :	Parkinson maladie; Age apparition; Précoce; Stimulus électrique; Chronique; Bilatéral; Noyau sousthalamique; Pallidum; Interne; Effet on off; Traitement instrumental; Modalité traitement; Etude comparative; Adulte
FG :	Homme; Système nerveux pathologie; Système nerveux central pathologie; Encéphale pathologie; Extrapyramidal syndrome; Maladie dégénérative; Stimulation instrumentale
ED :	Parkinson disease; Age of onset; Early; Electrical stimulus; Chronic; Bilateral; Subthalamic nucleus; Pallidum; Internal; On off effect; Instrumentation therapy; Application method; Comparative study; Adult
EG :	Human; Nervous system diseases; Central nervous system disease; Cerebral disorder; Extrapyramidal syndrome; Degenerative disease; Instrumental stimulation
GD :	Vergleich
SD :	Parkinson enfermedad; Edad aparición; Precoz; Estímulo eléctrico; Crónico; Bilateral; Núcleo subtalámico; Pallidum; Interno; Efecto on off; Tratamiento instrumental; Modalidad tratamiento; Estudio comparativo; Adulto
LO :	INIST-998.354000079064160070
ID :	98-0171789

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Pascal:98-0171789

Le document en format XML

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<term>Early</term>
<term>Electrical stimulus</term>
<term>Instrumentation therapy</term>
<term>Internal</term>
<term>On off effect</term>
<term>Pallidum</term>
<term>Parkinson disease</term>
<term>Subthalamic nucleus</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term>
<term>Age apparition</term>
<term>Précoce</term>
<term>Stimulus électrique</term>
<term>Chronique</term>
<term>Bilatéral</term>
<term>Noyau sousthalamique</term>
<term>Pallidum</term>
<term>Interne</term>
<term>Effet on off</term>
<term>Traitement instrumental</term>
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<front><div type="abstract" xml:lang="en">The aim of this study was to compare, retrospectively, the value of chronic bilateral stimulation of the internal globus pallidus (GPi) and the subthalamic nucleus (STN) in patients with young onset Parkinson's disease. We selected 13 consecutive patients with similar characteristics at the time of surgery: age at onset <40 years, disabling motor fluctuations (Hoehn and Yahr stage 4 or 5 in off-drug phases) and levodopa-induced dyskinesias (LID). Eight patients were operated on in the STN and five in the GPi. The Unified Parkinson's Disease Rating Scale (UPDRS), timed motor tests and a LID scale were compared in on- and off-drug conditions before surgery and 6 months after surgery on stimulation using the chronic electrical parameters found to improve best the motor state of the individual patient, without adverse effects. In off-drug phases, the motor score of the UPDRS was improved by 71% with STN stimulation and by 39% with GPi stimulation on average. This difference was statistically significant (P < 0.05). Whereas rigidity and tremor showed good improvement in both groups, the decrease in the akinesia score was more pronounced in the STN group. In the STN group, the improvement of all motor symptoms was very close, or equal, to the best levodopa response. Thus the levodopa test was predictive ofoutcome. The improvement in off-drug period motor handicap allowed a decrease in the levodopa-equivalent dose only in the STN group (-56%). The voltage, frequency and pulse width used for chronic stimulation were lower in the STN group. In the on-drug phases there was a marked improvement in LID in the GPi group, as measured by the dyskinesias score during an acute levodopa test, whereas there was only a small decrease in the STN group (P < 0.05). However in the long term, the reduction of levodopa dosage in the STN group led to an indirect reduction of LID similar to that in the GPi group during activities of everyday life. In conclusion, the overall results favour the neurosurgical treatment of Parkinson's disease by stimulating the STN rather than the GPi.</div>
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<fA11 i1="04" i2="1"><s1>HOFFMANN (D.)</s1>
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<fA11 i1="05" i2="1"><s1>XIE (J.)</s1>
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<fA11 i1="06" i2="1"><s1>BENAZZOUZ (A.)</s1>
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<fA11 i1="07" i2="1"><s1>BENABID (A. L.)</s1>
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<fA14 i1="01"><s1>Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble</s1>
<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>7 aut.</sZ>
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<fA20><s1>451-457</s1>
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<fA21><s1>1998</s1>
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<fC01 i1="01" l="ENG"><s0>The aim of this study was to compare, retrospectively, the value of chronic bilateral stimulation of the internal globus pallidus (GPi) and the subthalamic nucleus (STN) in patients with young onset Parkinson's disease. We selected 13 consecutive patients with similar characteristics at the time of surgery: age at onset <40 years, disabling motor fluctuations (Hoehn and Yahr stage 4 or 5 in off-drug phases) and levodopa-induced dyskinesias (LID). Eight patients were operated on in the STN and five in the GPi. The Unified Parkinson's Disease Rating Scale (UPDRS), timed motor tests and a LID scale were compared in on- and off-drug conditions before surgery and 6 months after surgery on stimulation using the chronic electrical parameters found to improve best the motor state of the individual patient, without adverse effects. In off-drug phases, the motor score of the UPDRS was improved by 71% with STN stimulation and by 39% with GPi stimulation on average. This difference was statistically significant (P < 0.05). Whereas rigidity and tremor showed good improvement in both groups, the decrease in the akinesia score was more pronounced in the STN group. In the STN group, the improvement of all motor symptoms was very close, or equal, to the best levodopa response. Thus the levodopa test was predictive ofoutcome. The improvement in off-drug period motor handicap allowed a decrease in the levodopa-equivalent dose only in the STN group (-56%). The voltage, frequency and pulse width used for chronic stimulation were lower in the STN group. In the on-drug phases there was a marked improvement in LID in the GPi group, as measured by the dyskinesias score during an acute levodopa test, whereas there was only a small decrease in the STN group (P < 0.05). However in the long term, the reduction of levodopa dosage in the STN group led to an indirect reduction of LID similar to that in the GPi group during activities of everyday life. In conclusion, the overall results favour the neurosurgical treatment of Parkinson's disease by stimulating the STN rather than the GPi.</s0>
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<s5>02</s5>
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<s5>02</s5>
</fC03>
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<s5>02</s5>
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<fC03 i1="03" i2="X" l="FRE"><s0>Précoce</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>Early</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Precoz</s0>
<s5>03</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Stimulus électrique</s0>
<s5>04</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Electrical stimulus</s0>
<s5>04</s5>
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<s5>04</s5>
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<s5>05</s5>
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<s5>05</s5>
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<s5>05</s5>
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<s5>06</s5>
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<s5>06</s5>
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<s5>10</s5>
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<s5>10</s5>
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<s5>17</s5>
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<s5>17</s5>
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<s5>37</s5>
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<fC07 i1="04" i2="X" l="ENG"><s0>Cerebral disorder</s0>
<s5>39</s5>
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<fC07 i1="04" i2="X" l="SPA"><s0>Encéfalo patología</s0>
<s5>39</s5>
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<s5>40</s5>
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<s5>40</s5>
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<s5>40</s5>
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<s5>41</s5>
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<s5>41</s5>
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<server><NO>PASCAL 98-0171789 INIST</NO>
<ET>Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson disease</ET>
<AU>KRACK (P.); POLLAK (P.); LIMOUSIN (P.); HOFFMANN (D.); XIE (J.); BENAZZOUZ (A.); BENABID (A. L.)</AU>
<AF>Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble/France (1 aut., 2 aut., 3 aut., 4 aut., 5 aut., 6 aut., 7 aut.)</AF>
<DT>Publication en série; Niveau analytique</DT>
<SO>Brain; ISSN 0006-8950; Royaume-Uni; Da. 1998; Vol. 121; No. p.3; Pp. 451-457; Bibl. 30 ref.</SO>
<LA>Anglais</LA>
<EA>The aim of this study was to compare, retrospectively, the value of chronic bilateral stimulation of the internal globus pallidus (GPi) and the subthalamic nucleus (STN) in patients with young onset Parkinson's disease. We selected 13 consecutive patients with similar characteristics at the time of surgery: age at onset <40 years, disabling motor fluctuations (Hoehn and Yahr stage 4 or 5 in off-drug phases) and levodopa-induced dyskinesias (LID). Eight patients were operated on in the STN and five in the GPi. The Unified Parkinson's Disease Rating Scale (UPDRS), timed motor tests and a LID scale were compared in on- and off-drug conditions before surgery and 6 months after surgery on stimulation using the chronic electrical parameters found to improve best the motor state of the individual patient, without adverse effects. In off-drug phases, the motor score of the UPDRS was improved by 71% with STN stimulation and by 39% with GPi stimulation on average. This difference was statistically significant (P < 0.05). Whereas rigidity and tremor showed good improvement in both groups, the decrease in the akinesia score was more pronounced in the STN group. In the STN group, the improvement of all motor symptoms was very close, or equal, to the best levodopa response. Thus the levodopa test was predictive ofoutcome. The improvement in off-drug period motor handicap allowed a decrease in the levodopa-equivalent dose only in the STN group (-56%). The voltage, frequency and pulse width used for chronic stimulation were lower in the STN group. In the on-drug phases there was a marked improvement in LID in the GPi group, as measured by the dyskinesias score during an acute levodopa test, whereas there was only a small decrease in the STN group (P < 0.05). However in the long term, the reduction of levodopa dosage in the STN group led to an indirect reduction of LID similar to that in the GPi group during activities of everyday life. In conclusion, the overall results favour the neurosurgical treatment of Parkinson's disease by stimulating the STN rather than the GPi.</EA>
<CC>002B26I</CC>
<FD>Parkinson maladie; Age apparition; Précoce; Stimulus électrique; Chronique; Bilatéral; Noyau sousthalamique; Pallidum; Interne; Effet on off; Traitement instrumental; Modalité traitement; Etude comparative; Adulte</FD>
<FG>Homme; Système nerveux pathologie; Système nerveux central pathologie; Encéphale pathologie; Extrapyramidal syndrome; Maladie dégénérative; Stimulation instrumentale</FG>
<ED>Parkinson disease; Age of onset; Early; Electrical stimulus; Chronic; Bilateral; Subthalamic nucleus; Pallidum; Internal; On off effect; Instrumentation therapy; Application method; Comparative study; Adult</ED>
<EG>Human; Nervous system diseases; Central nervous system disease; Cerebral disorder; Extrapyramidal syndrome; Degenerative disease; Instrumental stimulation</EG>
<GD>Vergleich</GD>
<SD>Parkinson enfermedad; Edad aparición; Precoz; Estímulo eléctrico; Crónico; Bilateral; Núcleo subtalámico; Pallidum; Interno; Efecto on off; Tratamiento instrumental; Modalidad tratamiento; Estudio comparativo; Adulto</SD>
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	La maladie de Parkinson en France (serveur d'exploration)
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La maladie de Parkinson en France (serveur d'exploration)

Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson disease

Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson disease

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