Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation
Identifieur interne : 000488 ( Pmc/Curation ); précédent : 000487; suivant : 000489Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation
Auteurs : B. Bejjani ; D. Gervais ; I. Arnulf ; S. Papadopoulos ; S. Demeret ; A. Bonnet ; P. Cornu ; P. Damier ; Y. AgidSource :
- Journal of Neurology, Neurosurgery, and Psychiatry [ 0022-3050 ] ; 2000.
Abstract
Url:
DOI: 10.1136/jnnp.68.5.595
PubMed: 10766889
PubMed Central: 1736917
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PMC:1736917Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Axial parkinsonian symptoms can be improved: the role of levodopa
and bilateral subthalamic stimulation</title>
<author><name sortKey="Bejjani, B" sort="Bejjani, B" uniqKey="Bejjani B" first="B." last="Bejjani">B. Bejjani</name>
</author>
<author><name sortKey="Gervais, D" sort="Gervais, D" uniqKey="Gervais D" first="D." last="Gervais">D. Gervais</name>
</author>
<author><name sortKey="Arnulf, I" sort="Arnulf, I" uniqKey="Arnulf I" first="I." last="Arnulf">I. Arnulf</name>
</author>
<author><name sortKey="Papadopoulos, S" sort="Papadopoulos, S" uniqKey="Papadopoulos S" first="S." last="Papadopoulos">S. Papadopoulos</name>
</author>
<author><name sortKey="Demeret, S" sort="Demeret, S" uniqKey="Demeret S" first="S." last="Demeret">S. Demeret</name>
</author>
<author><name sortKey="Bonnet, A" sort="Bonnet, A" uniqKey="Bonnet A" first="A." last="Bonnet">A. Bonnet</name>
</author>
<author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P." last="Cornu">P. Cornu</name>
</author>
<author><name sortKey="Damier, P" sort="Damier, P" uniqKey="Damier P" first="P." last="Damier">P. Damier</name>
</author>
<author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Y. Agid</name>
</author>
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<idno type="pmc">1736917</idno>
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<idno type="doi">10.1136/jnnp.68.5.595</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Axial parkinsonian symptoms can be improved: the role of levodopa
and bilateral subthalamic stimulation</title>
<author><name sortKey="Bejjani, B" sort="Bejjani, B" uniqKey="Bejjani B" first="B." last="Bejjani">B. Bejjani</name>
</author>
<author><name sortKey="Gervais, D" sort="Gervais, D" uniqKey="Gervais D" first="D." last="Gervais">D. Gervais</name>
</author>
<author><name sortKey="Arnulf, I" sort="Arnulf, I" uniqKey="Arnulf I" first="I." last="Arnulf">I. Arnulf</name>
</author>
<author><name sortKey="Papadopoulos, S" sort="Papadopoulos, S" uniqKey="Papadopoulos S" first="S." last="Papadopoulos">S. Papadopoulos</name>
</author>
<author><name sortKey="Demeret, S" sort="Demeret, S" uniqKey="Demeret S" first="S." last="Demeret">S. Demeret</name>
</author>
<author><name sortKey="Bonnet, A" sort="Bonnet, A" uniqKey="Bonnet A" first="A." last="Bonnet">A. Bonnet</name>
</author>
<author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P." last="Cornu">P. Cornu</name>
</author>
<author><name sortKey="Damier, P" sort="Damier, P" uniqKey="Damier P" first="P." last="Damier">P. Damier</name>
</author>
<author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Y. Agid</name>
</author>
</analytic>
<series><title level="j">Journal of Neurology, Neurosurgery, and Psychiatry</title>
<idno type="ISSN">0022-3050</idno>
<idno type="eISSN">1468-330X</idno>
<imprint><date when="2000">2000</date>
</imprint>
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<front><div type="abstract" xml:lang="en"><p><italic>OBJECTIVE</italic>
—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).
<italic>METHODS</italic>
—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).
<italic>RESULTS</italic>
—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.
<italic>CONCLUSION</italic>
—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.
</p>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id>
<journal-title>Journal of Neurology, Neurosurgery, and Psychiatry</journal-title>
<issn pub-type="ppub">0022-3050</issn>
<issn pub-type="epub">1468-330X</issn>
<publisher><publisher-name>BMJ Group</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">10766889</article-id>
<article-id pub-id-type="pmc">1736917</article-id>
<article-id pub-id-type="doi">10.1136/jnnp.68.5.595</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Papers</subject>
</subj-group>
</article-categories>
<title-group><article-title>Axial parkinsonian symptoms can be improved: the role of levodopa
and bilateral subthalamic stimulation</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Bejjani</surname>
<given-names>B.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Gervais</surname>
<given-names>D.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Arnulf</surname>
<given-names>I.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Papadopoulos</surname>
<given-names>S.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Demeret</surname>
<given-names>S.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Bonnet</surname>
<given-names>A.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Cornu</surname>
<given-names>P.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Damier</surname>
<given-names>P.</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Agid</surname>
<given-names>Y.</given-names>
</name>
</contrib>
</contrib-group>
<aff>Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289, France.</aff>
<pub-date pub-type="ppub"><month>5</month>
<year>2000</year>
</pub-date>
<volume>68</volume>
<issue>5</issue>
<fpage>595</fpage>
<lpage>600</lpage>
<self-uri xlink:role="pdf" xlink:type="simple" xlink:href="http://jnnp.bmj.com/cgi/reprint/68/5/595.pdf"></self-uri>
<self-uri xlink:role="abstract" xlink:type="simple" xlink:href="http://jnnp.bmj.com/cgi/content/abstract/68/5/595"></self-uri>
<self-uri xlink:role="fulltext" xlink:type="simple" xlink:href="http://jnnp.bmj.com/cgi/content/full/68/5/595"></self-uri>
<abstract><p><italic>OBJECTIVE</italic>
—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).
<italic>METHODS</italic>
—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).
<italic>RESULTS</italic>
—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.
<italic>CONCLUSION</italic>
—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.
</p>
</abstract>
</article-meta>
</front>
</pmc>
</record>
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