Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease.
Identifieur interne : 001321 ( PubMed/Checkpoint ); précédent : 001320; suivant : 001322Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease.
Auteurs : P. Krack [France] ; P. Pollak ; P. Limousin ; D. Hoffmann ; J. Xie ; A. Benazzouz ; A L BenabidSource :
- Brain : a journal of neurology [ 0006-8950 ] ; 1998.
English descriptors
- KwdEn :
- Adult, Age of Onset, Dyskinesia, Drug-Induced (physiopathology), Electric Stimulation, Electrodes, Implanted, Female, Globus Pallidus (physiopathology), Globus Pallidus (surgery), Humans, Levodopa (adverse effects), Male, Middle Aged, Parkinson Disease (drug therapy), Parkinson Disease (epidemiology), Parkinson Disease (physiopathology), Retrospective Studies, Severity of Illness Index, Thalamic Nuclei (physiopathology), Thalamic Nuclei (surgery).
- MESH :
- chemical , adverse effects : Levodopa.
- drug therapy : Parkinson Disease.
- epidemiology : Parkinson Disease.
- physiopathology : Dyskinesia, Drug-Induced, Globus Pallidus, Parkinson Disease, Thalamic Nuclei.
- surgery : Globus Pallidus, Thalamic Nuclei.
- Adult, Age of Onset, Electric Stimulation, Electrodes, Implanted, Female, Humans, Male, Middle Aged, Retrospective Studies, Severity of Illness Index.
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 of outcome. 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.
PubMed: 9549521
Affiliations:
Links toward previous steps (curation, corpus...)
Links to Exploration step
pubmed:9549521Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease.</title><author><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P" last="Krack">P. Krack</name><affiliation wicri:level="1"><nlm:affiliation>Department of Clinical and Biological Neurosciences, Joseph Fourier University of Grenoble, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Clinical and Biological Neurosciences, Joseph Fourier University of Grenoble</wicri:regionArea><wicri:noRegion>Joseph Fourier University of Grenoble</wicri:noRegion><wicri:noRegion>Joseph Fourier University of Grenoble</wicri:noRegion></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P" last="Pollak">P. Pollak</name></author><author><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P" last="Limousin">P. Limousin</name></author><author><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D" last="Hoffmann">D. Hoffmann</name></author><author><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J" last="Xie">J. Xie</name></author><author><name sortKey="Benazzouz, A" sort="Benazzouz, A" uniqKey="Benazzouz A" first="A" last="Benazzouz">A. Benazzouz</name></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A L" last="Benabid">A L Benabid</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="1998">1998</date><idno type="RBID">pubmed:9549521</idno><idno type="pmid">9549521</idno><idno type="wicri:Area/PubMed/Corpus">001480</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001480</idno><idno type="wicri:Area/PubMed/Curation">001439</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">001439</idno><idno type="wicri:Area/PubMed/Checkpoint">001439</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">001439</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease.</title><author><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P" last="Krack">P. Krack</name><affiliation wicri:level="1"><nlm:affiliation>Department of Clinical and Biological Neurosciences, Joseph Fourier University of Grenoble, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Clinical and Biological Neurosciences, Joseph Fourier University of Grenoble</wicri:regionArea><wicri:noRegion>Joseph Fourier University of Grenoble</wicri:noRegion><wicri:noRegion>Joseph Fourier University of Grenoble</wicri:noRegion></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P" last="Pollak">P. Pollak</name></author><author><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P" last="Limousin">P. Limousin</name></author><author><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D" last="Hoffmann">D. Hoffmann</name></author><author><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J" last="Xie">J. Xie</name></author><author><name sortKey="Benazzouz, A" sort="Benazzouz, A" uniqKey="Benazzouz A" first="A" last="Benazzouz">A. Benazzouz</name></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A L" last="Benabid">A L Benabid</name></author></analytic><series><title level="j">Brain : a journal of neurology</title><idno type="ISSN">0006-8950</idno><imprint><date when="1998" type="published">1998</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Age of Onset</term><term>Dyskinesia, Drug-Induced (physiopathology)</term><term>Electric Stimulation</term><term>Electrodes, Implanted</term><term>Female</term><term>Globus Pallidus (physiopathology)</term><term>Globus Pallidus (surgery)</term><term>Humans</term><term>Levodopa (adverse effects)</term><term>Male</term><term>Middle Aged</term><term>Parkinson Disease (drug therapy)</term><term>Parkinson Disease (epidemiology)</term><term>Parkinson Disease (physiopathology)</term><term>Retrospective Studies</term><term>Severity of Illness Index</term><term>Thalamic Nuclei (physiopathology)</term><term>Thalamic Nuclei (surgery)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Dyskinesia, Drug-Induced</term><term>Globus Pallidus</term><term>Parkinson Disease</term><term>Thalamic Nuclei</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Globus Pallidus</term><term>Thalamic Nuclei</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Age of Onset</term><term>Electric Stimulation</term><term>Electrodes, Implanted</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Retrospective Studies</term><term>Severity of Illness Index</term></keywords></textClass></profileDesc></teiHeader><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 of outcome. 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></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">9549521</PMID><DateCreated><Year>1998</Year><Month>05</Month><Day>08</Day></DateCreated><DateCompleted><Year>1998</Year><Month>05</Month><Day>08</Day></DateCompleted><DateRevised><Year>2013</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0006-8950</ISSN><JournalIssue CitedMedium="Print"><Volume>121 ( Pt 3)</Volume><PubDate><Year>1998</Year><Month>Mar</Month></PubDate></JournalIssue><Title>Brain : a journal of neurology</Title><ISOAbbreviation>Brain</ISOAbbreviation></Journal><ArticleTitle>Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease.</ArticleTitle><Pagination><MedlinePgn>451-7</MedlinePgn></Pagination><Abstract><AbstractText>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 of outcome. 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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Krack</LastName><ForeName>P</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Clinical and Biological Neurosciences, Joseph Fourier University of Grenoble, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pollak</LastName><ForeName>P</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Limousin</LastName><ForeName>P</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Hoffmann</LastName><ForeName>D</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Xie</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Benazzouz</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Benabid</LastName><ForeName>A L</ForeName><Initials>AL</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Brain</MedlineTA><NlmUniqueID>0372537</NlmUniqueID><ISSNLinking>0006-8950</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>46627O600J</RegistryNumber><NameOfSubstance UI="D007980">Levodopa</NameOfSubstance></Chemical></ChemicalList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017668" MajorTopicYN="N">Age of Onset</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004409" MajorTopicYN="N">Dyskinesia, Drug-Induced</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004558" MajorTopicYN="N">Electric Stimulation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004567" MajorTopicYN="N">Electrodes, Implanted</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005917" MajorTopicYN="N">Globus Pallidus</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007980" MajorTopicYN="N">Levodopa</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010300" MajorTopicYN="N">Parkinson Disease</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013787" MajorTopicYN="N">Thalamic Nuclei</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>1998</Year><Month>4</Month><Day>29</Day></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>1998</Year><Month>4</Month><Day>29</Day><Hour>0</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>1998</Year><Month>4</Month><Day>29</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">9549521</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>France</li></country></list><tree><noCountry><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A L" last="Benabid">A L Benabid</name><name sortKey="Benazzouz, A" sort="Benazzouz, A" uniqKey="Benazzouz A" first="A" last="Benazzouz">A. Benazzouz</name><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D" last="Hoffmann">D. Hoffmann</name><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P" last="Limousin">P. Limousin</name><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P" last="Pollak">P. Pollak</name><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J" last="Xie">J. Xie</name></noCountry><country name="France"><noRegion><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P" last="Krack">P. Krack</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/ParkinsonFranceV1/Data/PubMed/Checkpoint
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001321 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/PubMed/Checkpoint/biblio.hfd -nk 001321 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= ParkinsonFranceV1
|flux= PubMed
|étape= Checkpoint
|type= RBID
|clé= pubmed:9549521
|texte= Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease.
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/PubMed/Checkpoint/RBID.i -Sk "pubmed:9549521" \
| HfdSelect -Kh $EXPLOR_AREA/Data/PubMed/Checkpoint/biblio.hfd \
| NlmPubMed2Wicri -a ParkinsonFranceV1
| This area was generated with Dilib version V0.6.29. |  |