Axial parkinsonian symptoms can be improved : The role of levodopa and bilateral subthalamic stimulation
Identifieur interne : 000044 ( PascalFrancis/Curation ); précédent : 000043; suivant : 000045Axial parkinsonian symptoms can be improved : The role of levodopa and bilateral subthalamic stimulation
Auteurs : B.-P. Bejjani [France, Liban] ; D. Gervais [France] ; I. Arnulf [France] ; S. Papadopoulos [France] ; S. Demeret [France] ; A.-M. Bonnet [France] ; P. Cornu [France] ; P. Damier [France] ; Y. Agid [France]Source :
- Journal of neurology, neurosurgery and psychiatry [ 0022-3050 ] ; 2000.
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- topic : Adulte.
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Abstract
Objective-To assess the effects of high frequency stimulation of the subthalamic nucleus (STN) on axial symptoms occurring in advanced stages of Parkinson's disease (PD). Methods-The efficacy of STN stimulation on total motor disability score (unified Parkinson's disease rating scale (UPDRS) part III) were evaluated in 10 patients with severe Parkinson's disease. The subscores were then studied separately for limb akinesia, rigidity, and tremor, which are known to respond to levodopa, and axial signs, including speech, neck rigidity, rising from a chair, posture, gait, and postural stability, which are known to respond less well to levodopa. Patients were clinically assessed in the "off" and "on" drug condition during a levodopa challenge test performed before surgical implantation of stimulation electrodes and repeated 6 months after surgery under continuous STN stimulation. A complementary score for axial symptoms from the "activities of daily living" (ADL)-that is, speech, swallowing, turning in bed, falling, walking, and freezing-was obtained from each patient's questionnaire (UPDRS, part II). Results-Improvements in total motor disability score (62%), limb signs (62%), and axial signs (72%) obtained with STN stimulation were statistically comparable with those obtained with levodopa during the preoperative challenge (68%, 69%, and 59%, respectively). When levodopa and STN stimulation were combined there was a further improvement in total motor disability (80%) compared with preoperative levodopa administration. This consisted largely of an additional improvement in axial signs (84%) mainly for posture and postural stability, no further improvement in levodopa responsive signs being found. Axial symptoms from the ADL showed similar additional improvement when levodopa and STN stimulation were combined. Conclusion-These findings suggest that bilateral STN stimulation improves most axial features of Parkinson's disease and that a synergistic effect can be obtained when stimulation is used in conjunction with levodopa treatment.
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Agid</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">00-0239484</idno><date when="2000">2000</date><idno type="stanalyst">PASCAL 00-0239484 INIST</idno><idno type="RBID">Pascal:00-0239484</idno><idno type="wicri:Area/PascalFrancis/Corpus">001394</idno><idno type="wicri:Area/PascalFrancis/Curation">000044</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Axial parkinsonian symptoms can be improved : The role of levodopa and bilateral subthalamic stimulation</title><author><name sortKey="Bejjani, B P" sort="Bejjani, B P" uniqKey="Bejjani B" first="B.-P." last="Bejjani">B.-P. Bejjani</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Departement de Neurologie, Hôpital Hôtel-Dieu de France, USJ</s1><s2>Beirut</s2><s3>LBN</s3><sZ>1 aut.</sZ></inist:fA14><country>Liban</country></affiliation></author><author><name sortKey="Gervais, D" sort="Gervais, D" uniqKey="Gervais D" first="D." last="Gervais">D. Gervais</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Arnulf, I" sort="Arnulf, I" uniqKey="Arnulf I" first="I." last="Arnulf">I. Arnulf</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Papadopoulos, S" sort="Papadopoulos, S" uniqKey="Papadopoulos S" first="S." last="Papadopoulos">S. Papadopoulos</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Demeret, S" sort="Demeret, S" uniqKey="Demeret S" first="S." last="Demeret">S. Demeret</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A.-M." last="Bonnet">A.-M. Bonnet</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P." last="Cornu">P. Cornu</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Département de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Damier, P" sort="Damier, P" uniqKey="Damier P" first="P." last="Damier">P. Damier</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Y. Agid</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country></affiliation></author></analytic><series><title level="j" type="main">Journal of neurology, neurosurgery and psychiatry</title><title level="j" type="abbreviated">J. neurol. neurosurg. psychiatry</title><idno type="ISSN">0022-3050</idno><imprint><date when="2000">2000</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of neurology, neurosurgery and psychiatry</title><title level="j" type="abbreviated">J. neurol. neurosurg. psychiatry</title><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Advanced stage</term><term>Antiparkinson agent</term><term>Bilateral</term><term>Chemotherapy</term><term>Combined treatment</term><term>Electrical stimulus</term><term>Evolution</term><term>Instrumentation therapy</term><term>Levodopa</term><term>Parkinson disease</term><term>Subthalamic nucleus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Stade avancé</term><term>Stimulus électrique</term><term>Noyau sousthalamique</term><term>Bilatéral</term><term>Lévodopa</term><term>Chimiothérapie</term><term>Antiparkinsonien</term><term>Traitement instrumental</term><term>Traitement associé</term><term>Evolution</term><term>Adulte</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Adulte</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective-To assess the effects of high frequency stimulation of the subthalamic nucleus (STN) on axial symptoms occurring in advanced stages of Parkinson's disease (PD). Methods-The efficacy of STN stimulation on total motor disability score (unified Parkinson's disease rating scale (UPDRS) part III) were evaluated in 10 patients with severe Parkinson's disease. The subscores were then studied separately for limb akinesia, rigidity, and tremor, which are known to respond to levodopa, and axial signs, including speech, neck rigidity, rising from a chair, posture, gait, and postural stability, which are known to respond less well to levodopa. Patients were clinically assessed in the "off" and "on" drug condition during a levodopa challenge test performed before surgical implantation of stimulation electrodes and repeated 6 months after surgery under continuous STN stimulation. A complementary score for axial symptoms from the "activities of daily living" (ADL)-that is, speech, swallowing, turning in bed, falling, walking, and freezing-was obtained from each patient's questionnaire (UPDRS, part II). Results-Improvements in total motor disability score (62%), limb signs (62%), and axial signs (72%) obtained with STN stimulation were statistically comparable with those obtained with levodopa during the preoperative challenge (68%, 69%, and 59%, respectively). When levodopa and STN stimulation were combined there was a further improvement in total motor disability (80%) compared with preoperative levodopa administration. This consisted largely of an additional improvement in axial signs (84%) mainly for posture and postural stability, no further improvement in levodopa responsive signs being found. Axial symptoms from the ADL showed similar additional improvement when levodopa and STN stimulation were combined. Conclusion-These findings suggest that bilateral STN stimulation improves most axial features of Parkinson's disease and that a synergistic effect can be obtained when stimulation is used in conjunction with levodopa treatment.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0022-3050</s0></fA01><fA02 i1="01"><s0>JNNPAU</s0></fA02><fA03 i2="1"><s0>J. neurol. neurosurg. psychiatry</s0></fA03><fA05><s2>68</s2></fA05><fA06><s2>5</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Axial parkinsonian symptoms can be improved : The role of levodopa and bilateral subthalamic stimulation</s1></fA08><fA11 i1="01" i2="1"><s1>BEJJANI (B.-P.)</s1></fA11><fA11 i1="02" i2="1"><s1>GERVAIS (D.)</s1></fA11><fA11 i1="03" i2="1"><s1>ARNULF (I.)</s1></fA11><fA11 i1="04" i2="1"><s1>PAPADOPOULOS (S.)</s1></fA11><fA11 i1="05" i2="1"><s1>DEMERET (S.)</s1></fA11><fA11 i1="06" i2="1"><s1>BONNET (A.-M.)</s1></fA11><fA11 i1="07" i2="1"><s1>CORNU (P.)</s1></fA11><fA11 i1="08" i2="1"><s1>DAMIER (P.)</s1></fA11><fA11 i1="09" i2="1"><s1>AGID (Y.)</s1></fA11><fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289</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>8 aut.</sZ><sZ>9 aut.</sZ></fA14><fA14 i1="02"><s1>Departement de Neurologie, Hôpital Hôtel-Dieu de France, USJ</s1><s2>Beirut</s2><s3>LBN</s3><sZ>1 aut.</sZ></fA14><fA14 i1="03"><s1>Département de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ></fA14><fA20><s1>595-600</s1></fA20><fA21><s1>2000</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>6015</s2><s5>354000087420180080</s5></fA43><fA44><s0>0000</s0><s1>© 2000 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>24 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>00-0239484</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Journal of neurology, neurosurgery and psychiatry</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>Objective-To assess the effects of high frequency stimulation of the subthalamic nucleus (STN) on axial symptoms occurring in advanced stages of Parkinson's disease (PD). Methods-The efficacy of STN stimulation on total motor disability score (unified Parkinson's disease rating scale (UPDRS) part III) were evaluated in 10 patients with severe Parkinson's disease. The subscores were then studied separately for limb akinesia, rigidity, and tremor, which are known to respond to levodopa, and axial signs, including speech, neck rigidity, rising from a chair, posture, gait, and postural stability, which are known to respond less well to levodopa. Patients were clinically assessed in the "off" and "on" drug condition during a levodopa challenge test performed before surgical implantation of stimulation electrodes and repeated 6 months after surgery under continuous STN stimulation. A complementary score for axial symptoms from the "activities of daily living" (ADL)-that is, speech, swallowing, turning in bed, falling, walking, and freezing-was obtained from each patient's questionnaire (UPDRS, part II). Results-Improvements in total motor disability score (62%), limb signs (62%), and axial signs (72%) obtained with STN stimulation were statistically comparable with those obtained with levodopa during the preoperative challenge (68%, 69%, and 59%, respectively). When levodopa and STN stimulation were combined there was a further improvement in total motor disability (80%) compared with preoperative levodopa administration. This consisted largely of an additional improvement in axial signs (84%) mainly for posture and postural stability, no further improvement in levodopa responsive signs being found. Axial symptoms from the ADL showed similar additional improvement when levodopa and STN stimulation were combined. Conclusion-These findings suggest that bilateral STN stimulation improves most axial features of Parkinson's disease and that a synergistic effect can be obtained when stimulation is used in conjunction with levodopa treatment.</s0></fC01><fC02 i1="01" i2="X"><s0>002B26I</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>Stade avancé</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Advanced stage</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Estadio avanzado</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Stimulus électrique</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Electrical stimulus</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Estímulo eléctrico</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Noyau sousthalamique</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Subthalamic nucleus</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Núcleo subtalámico</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Bilatéral</s0><s5>06</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Bilateral</s0><s5>06</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Bilateral</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Lévodopa</s0><s5>07</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Levodopa</s0><s5>07</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Levodopa</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Chimiothérapie</s0><s5>08</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Chemotherapy</s0><s5>08</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Quimioterapia</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Antiparkinsonien</s0><s5>09</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Antiparkinson agent</s0><s5>09</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Antiparkinsoniano</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Traitement instrumental</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Instrumentation therapy</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Tratamiento instrumental</s0><s5>17</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Traitement associé</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Combined treatment</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Tratamiento asociado</s0><s5>18</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Evolution</s0><s5>19</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Evolution</s0><s5>19</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Evolución</s0><s5>19</s5></fC03><fC03 i1="12" i2="X" l="FRE"><s0>Adulte</s0><s5>20</s5></fC03><fC03 i1="12" i2="X" l="ENG"><s0>Adult</s0><s5>20</s5></fC03><fC03 i1="12" i2="X" l="SPA"><s0>Adulto</s0><s5>20</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Homme</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Human</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Hombre</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>38</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>40</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>41</s5></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Stimulation instrumentale</s0><s5>45</s5></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Instrumental stimulation</s0><s5>45</s5></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Estimulación instrumental</s0><s5>45</s5></fC07><fN21><s1>164</s1></fN21></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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