Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up
Identifieur interne : 000154 ( France/Analysis ); précédent : 000153; suivant : 000155Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up
Auteurs : W M M. Schüpbach [France] ; N. Chastan [France] ; M L Welter [France] ; J L Houeto [France] ; V. Mesnage [France] ; A M Bonnet [France] ; V. Czernecki [France] ; D. Maltête [France] ; A. Hartmann [France] ; L. Mallet [France] ; B. Pidoux [France] ; D. Dormont [France] ; S. Navarro [France] ; P. Cornu [France] ; A. Mallet [France] ; Yves Agid [France]Source :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2005-12.
English descriptors
- KwdEn :
Abstract
Background: The short term benefits of bilateral stimulation of the subthalamic nucleus (STN) in patients with advanced levodopa responsive Parkinson’s disease (PD) are well documented, but long term benefits are still uncertain. Objectives: This study provides a 5 year follow up of PD patients treated with stimulation of the STN. Methods: Thirty seven consecutive patients with PD treated with bilateral STN stimulation were assessed prospectively 6, 24, and 60 months after neurosurgery. Parkinsonian motor disability was evaluated with and without levodopa treatment, with and without bilateral STN stimulation. Neuropsychological and mood assessments included the Mattis Dementia Rating Scale, the frontal score, and the Montgomery-Asberg Depression Rating Scale (MADRS). Results: No severe peri- or immediate postoperative side effects were observed. Six patients died and one was lost to follow up. Five years after neurosurgery: (i) activity of daily living (Unified Parkinson Disease Rating Scale (UPDRS) II) was improved by stimulation of the STN by 40% (“off” drug) and 60% (“on” drug); (ii) parkinsonian motor disability (UPDRS III) was improved by 54% (“off” drug) and 73% (“on” drug); (iii) the severity of levodopa related motor complications was decreased by 67% and the levodopa daily doses were reduced by 58%. The MADRS was unchanged, but cognitive performance declined significantly. Persisting adverse effects included eyelid opening apraxia, weight gain, addiction to levodopa treatment, hypomania and disinhibition, depression, dysarthria, dyskinesias, and apathy. Conclusions: Despite moderate motor and cognitive decline, probably due to disease progression, the marked improvement in motor function observed postoperatively was sustained 5 years after neurosurgery.
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DOI: 10.1136/jnnp.2005.063206
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Pidoux</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D" last="Dormont">D. Dormont</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Navarro, S" sort="Navarro, S" uniqKey="Navarro S" first="S" last="Navarro">S. Navarro</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P" last="Cornu">P. Cornu</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Mallet, A" sort="Mallet, A" uniqKey="Mallet A" first="A" last="Mallet">A. Mallet</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y" last="Agid">Yves Agid</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName><orgName type="hospital" n="4">Hôpital de la Salpêtrière</orgName></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2005-12">2005-12</date><biblScope unit="volume">76</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1640">1640</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B</idno><idno type="DOI">10.1136/jnnp.2005.063206</idno><idno type="href">jnnp-76-1640.pdf</idno><idno type="PMID">16291886</idno><idno type="local">0761640</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ADL, activities of daily living</term><term>IQR, interquartile range</term><term>MADRS, Montgomery-Asberg Depression Rating Scale</term><term>PD, Parkinson’s disease</term><term>Parkinson’s disease</term><term>SD, standard deviations</term><term>STN, subthalamic nucleus</term><term>UPDRS, Unified Parkinson Disease Rating Scale</term><term>stimulation</term><term>subthalamic nucleus</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: The short term benefits of bilateral stimulation of the subthalamic nucleus (STN) in patients with advanced levodopa responsive Parkinson’s disease (PD) are well documented, but long term benefits are still uncertain. Objectives: This study provides a 5 year follow up of PD patients treated with stimulation of the STN. Methods: Thirty seven consecutive patients with PD treated with bilateral STN stimulation were assessed prospectively 6, 24, and 60 months after neurosurgery. Parkinsonian motor disability was evaluated with and without levodopa treatment, with and without bilateral STN stimulation. Neuropsychological and mood assessments included the Mattis Dementia Rating Scale, the frontal score, and the Montgomery-Asberg Depression Rating Scale (MADRS). Results: No severe peri- or immediate postoperative side effects were observed. Six patients died and one was lost to follow up. Five years after neurosurgery: (i) activity of daily living (Unified Parkinson Disease Rating Scale (UPDRS) II) was improved by stimulation of the STN by 40% (“off” drug) and 60% (“on” drug); (ii) parkinsonian motor disability (UPDRS III) was improved by 54% (“off” drug) and 73% (“on” drug); (iii) the severity of levodopa related motor complications was decreased by 67% and the levodopa daily doses were reduced by 58%. The MADRS was unchanged, but cognitive performance declined significantly. Persisting adverse effects included eyelid opening apraxia, weight gain, addiction to levodopa treatment, hypomania and disinhibition, depression, dysarthria, dyskinesias, and apathy. Conclusions: Despite moderate motor and cognitive decline, probably due to disease progression, the marked improvement in motor function observed postoperatively was sustained 5 years after neurosurgery.</div></front></TEI><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"><noRegion><name sortKey="Schupbach, W M M" sort="Schupbach, W M M" uniqKey="Schupbach W" first="W M M" last="Schüpbach">W M M. Schüpbach</name></noRegion><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y" last="Agid">Yves Agid</name><name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A M" last="Bonnet">A M Bonnet</name><name sortKey="Chastan, N" sort="Chastan, N" uniqKey="Chastan N" first="N" last="Chastan">N. Chastan</name><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P" last="Cornu">P. Cornu</name><name sortKey="Czernecki, V" sort="Czernecki, V" uniqKey="Czernecki V" first="V" last="Czernecki">V. Czernecki</name><name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D" last="Dormont">D. Dormont</name><name sortKey="Hartmann, A" sort="Hartmann, A" uniqKey="Hartmann A" first="A" last="Hartmann">A. Hartmann</name><name sortKey="Houeto, J L" sort="Houeto, J L" uniqKey="Houeto J" first="J L" last="Houeto">J L Houeto</name><name sortKey="Mallet, A" sort="Mallet, A" uniqKey="Mallet A" first="A" last="Mallet">A. Mallet</name><name sortKey="Mallet, L" sort="Mallet, L" uniqKey="Mallet L" first="L" last="Mallet">L. Mallet</name><name sortKey="Maltete, D" sort="Maltete, D" uniqKey="Maltete D" first="D" last="Maltête">D. Maltête</name><name sortKey="Mesnage, V" sort="Mesnage, V" uniqKey="Mesnage V" first="V" last="Mesnage">V. Mesnage</name><name sortKey="Navarro, S" sort="Navarro, S" uniqKey="Navarro S" first="S" last="Navarro">S. Navarro</name><name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B" last="Pidoux">B. Pidoux</name><name sortKey="Welter, M L" sort="Welter, M L" uniqKey="Welter M" first="M L" last="Welter">M L Welter</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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