Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up
Identifieur interne : 001096 ( Main/Corpus ); précédent : 001095; suivant : 001097Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up
Auteurs : W M M. Schüpbach ; N. Chastan ; M L Welter ; J L Houeto ; V. Mesnage ; A M Bonnet ; V. Czernecki ; D. Maltête ; A. Hartmann ; L. Mallet ; B. Pidoux ; D. Dormont ; S. Navarro ; P. Cornu ; A. Mallet ; Y. AgidSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2005-12.
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- 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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ISTEX:AFD26FC59AB3B41D892F2B19DE6D833F31BBD86BLe document en format XML
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Pidoux</name><affiliation><mods:affiliation>Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D" last="Dormont">D. Dormont</name><affiliation><mods:affiliation>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Navarro, S" sort="Navarro, S" uniqKey="Navarro S" first="S" last="Navarro">S. Navarro</name><affiliation><mods:affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P" last="Cornu">P. Cornu</name><affiliation><mods:affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Mallet, A" sort="Mallet, A" uniqKey="Mallet A" first="A" last="Mallet">A. Mallet</name><affiliation><mods:affiliation>Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y" last="Agid">Y. Agid</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B</idno><date when="2005" year="2005">2005</date><idno type="doi">10.1136/jnnp.2005.063206</idno><idno type="url">https://api.istex.fr/document/AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">001096</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up</title><author><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><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Chastan, N" sort="Chastan, N" uniqKey="Chastan N" first="N" last="Chastan">N. Chastan</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Welter, M L" sort="Welter, M L" uniqKey="Welter M" first="M L" last="Welter">M L Welter</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Houeto, J L" sort="Houeto, J L" uniqKey="Houeto J" first="J L" last="Houeto">J L Houeto</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Mesnage, V" sort="Mesnage, V" uniqKey="Mesnage V" first="V" last="Mesnage">V. Mesnage</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></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><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Czernecki, V" sort="Czernecki, V" uniqKey="Czernecki V" first="V" last="Czernecki">V. Czernecki</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Maltete, D" sort="Maltete, D" uniqKey="Maltete D" first="D" last="Maltête">D. Maltête</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Hartmann, A" sort="Hartmann, A" uniqKey="Hartmann A" first="A" last="Hartmann">A. Hartmann</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Mallet, L" sort="Mallet, L" uniqKey="Mallet L" first="L" last="Mallet">L. Mallet</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B" last="Pidoux">B. Pidoux</name><affiliation><mods:affiliation>Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D" last="Dormont">D. Dormont</name><affiliation><mods:affiliation>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Navarro, S" sort="Navarro, S" uniqKey="Navarro S" first="S" last="Navarro">S. Navarro</name><affiliation><mods:affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P" last="Cornu">P. Cornu</name><affiliation><mods:affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Mallet, A" sort="Mallet, A" uniqKey="Mallet A" first="A" last="Mallet">A. Mallet</name><affiliation><mods:affiliation>Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y" last="Agid">Y. Agid</name><affiliation><mods:affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</mods:affiliation></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><istex><corpusName>bmj</corpusName><author><json:item><name>W M M Schüpbach</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>N Chastan</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>M L Welter</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>J L Houeto</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>V Mesnage</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>A M Bonnet</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>V Czernecki</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>D Maltête</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>A Hartmann</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>L Mallet</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>B Pidoux</name><affiliations><json:string>Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>D Dormont</name><affiliations><json:string>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>S Navarro</name><affiliations><json:string>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>P Cornu</name><affiliations><json:string>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>A Mallet</name><affiliations><json:string>Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris, France</json:string></affiliations></json:item><json:item><name>Y Agid</name><affiliations><json:string>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Papers</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Memory disorders (neurology)</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Drugs: CNS (not psychiatric)</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Ophthalmology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Memory disorders (psychiatry)</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Mood disorders (including depression)</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ADL, activities of daily living</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>IQR, interquartile range</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>MADRS, Montgomery-Asberg Depression Rating Scale</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PD, Parkinson’s disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>SD, standard deviations</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STN, subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UPDRS, Unified Parkinson Disease Rating Scale</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson’s disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic nucleus</value></json:item></subject><language><json:string>eng</json:string></language><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.</abstract><qualityIndicators><score>7.063</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>17</keywordCount><abstractCharCount>1792</abstractCharCount><pdfWordCount>4063</pdfWordCount><pdfCharCount>27629</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>253</abstractWordCount></qualityIndicators><title>Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up</title><pmid><json:string>16291886</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>76</volume><pages><first>1640</first></pages><issn><json:string>0022-3050</json:string></issn><issue>12</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & Psychiatry</title></host><publicationDate>2005</publicationDate><copyrightDate>2005</copyrightDate><doi><json:string>10.1136/jnnp.2005.063206</json:string></doi><id>AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up</title><respStmt xml:id="ISTEX-API" resp="Références bibliographiques récupérées via GROBID" name="ISTEX-API (INIST-CNRS)"></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2005-11-16</date></publicationStmt><notesStmt><note>Correspondence to:
Dr Y Agid
Centre d’Investigation Clinique, Hôpital de la Salpêtrière, 47 boulevard de l’Hôpital, 75013 Paris, France; yves.agid@psl.ap-hop-paris.fr</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up</title><author><persName><forename type="first">W M M</forename><surname>Schüpbach</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">N</forename><surname>Chastan</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">M L</forename><surname>Welter</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">J L</forename><surname>Houeto</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">V</forename><surname>Mesnage</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">A M</forename><surname>Bonnet</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">V</forename><surname>Czernecki</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">D</forename><surname>Maltête</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">A</forename><surname>Hartmann</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">L</forename><surname>Mallet</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">B</forename><surname>Pidoux</surname></persName><affiliation>Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">D</forename><surname>Dormont</surname></persName><affiliation>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">S</forename><surname>Navarro</surname></persName><affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">P</forename><surname>Cornu</surname></persName><affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">A</forename><surname>Mallet</surname></persName><affiliation>Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris, France</affiliation></author><author><persName><forename type="first">Y</forename><surname>Agid</surname></persName><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2005-12"></date><biblScope unit="volume">76</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1640">1640</biblScope></imprint></monogr><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></fileDesc><profileDesc><creation><date>2005-11-16</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>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.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Memory disorders (neurology)</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Drugs: CNS (not psychiatric)</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Parkinson's disease</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Ophthalmology</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Memory disorders (psychiatry)</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Mood disorders (including depression)</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>ADL, activities of daily living</term></item><item><term>IQR, interquartile range</term></item><item><term>MADRS, Montgomery-Asberg Depression Rating Scale</term></item><item><term>PD, Parkinson’s disease</term></item><item><term>SD, standard deviations</term></item><item><term>STN, subthalamic nucleus</term></item><item><term>UPDRS, Unified Parkinson Disease Rating Scale</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>Parkinson’s disease</term></item><item><term>stimulation</term></item><item><term>subthalamic nucleus</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2005-11-16">Created</change><change when="2005-12">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-3-14">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">0761640</article-id><article-id pub-id-type="doi">10.1136/jnnp.2005.063206</article-id><article-id pub-id-type="other">jnnp;76/12/1640</article-id><article-id pub-id-type="pmid">16291886</article-id><article-id pub-id-type="other">1640</article-id><article-id pub-id-type="other">jnnp.2005.063206</article-id><article-categories><subj-group subj-group-type="heading"><subject content-type="original">Papers</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Memory disorders (neurology)</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Drugs: CNS (not psychiatric)</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Parkinson's disease</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Ophthalmology</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Memory disorders (psychiatry)</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Mood disorders (including depression)</subject></subj-group></article-categories><title-group><article-title>Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Schüpbach</surname><given-names>W M M</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Chastan</surname><given-names>N</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Welter</surname><given-names>M L</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Houeto</surname><given-names>J L</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mesnage</surname><given-names>V</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Bonnet</surname><given-names>A M</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Czernecki</surname><given-names>V</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Maltête</surname><given-names>D</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hartmann</surname><given-names>A</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mallet</surname><given-names>L</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Pidoux</surname><given-names>B</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Dormont</surname><given-names>D</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Navarro</surname><given-names>S</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Cornu</surname><given-names>P</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mallet</surname><given-names>A</given-names></name><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Agid</surname><given-names>Y</given-names></name><xref rid="AFF1">1</xref></contrib><aff id="AFF1"><label>1</label>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</aff><aff id="AFF2"><label>2</label>Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</aff><aff id="AFF3"><label>3</label>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</aff><aff id="AFF4"><label>4</label>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</aff><aff id="AFF5"><label>5</label>Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris, France</aff></contrib-group><author-notes><corresp>Correspondence to:
Dr Y Agid
Centre d’Investigation Clinique, Hôpital de la Salpêtrière, 47 boulevard de l’Hôpital, 75013 Paris, France; <ext-link xlink:href="yves.agidpsl.ap-hop-paris.fr" ext-link-type="email" xlink:type="simple">yves.agid@psl.ap-hop-paris.fr</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2005</year></pub-date><pub-date pub-type="epub"><day>16</day><month>11</month><year>2005</year></pub-date><volume>76</volume><volume-id pub-id-type="other">76</volume-id><volume-id pub-id-type="other">76</volume-id><issue>12</issue><issue-id pub-id-type="other">jnnp;76/12</issue-id><issue-id pub-id-type="other">12</issue-id><issue-id pub-id-type="other">76/12</issue-id><fpage>1640</fpage><history><date date-type="accepted"><day>11</day><month>04</month><year>2005</year></date><date date-type="received"><day>12</day><month>01</month><year>2005</year></date><date date-type="rev-recd"><day>23</day><month>03</month><year>2005</year></date></history><permissions><copyright-statement>Copyright 2005 Journal of Neurology Neurosurgery and Psychiatry</copyright-statement><copyright-year>2005</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-76-1640.pdf"></self-uri><abstract xml:lang="en"><p><bold>Background:</bold> 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.</p><p><bold>Objectives:</bold> This study provides a 5 year follow up of PD patients treated with stimulation of the STN.</p><p><bold>Methods:</bold> 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).</p><p><bold>Results:</bold> 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.</p><p><bold>Conclusions:</bold> 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.</p></abstract><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>ADL, activities of daily living</kwd><kwd>IQR, interquartile range</kwd><kwd>MADRS, Montgomery-Asberg Depression Rating Scale</kwd><kwd>PD, Parkinson’s disease</kwd><kwd>SD, standard deviations</kwd><kwd>STN, subthalamic nucleus</kwd><kwd>UPDRS, Unified Parkinson Disease Rating Scale</kwd></kwd-group><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>Parkinson’s disease</kwd><kwd>stimulation</kwd><kwd>subthalamic nucleus</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up</title></titleInfo><name type="personal"><namePart type="given">W M M</namePart><namePart type="family">Schüpbach</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N</namePart><namePart type="family">Chastan</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M L</namePart><namePart type="family">Welter</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J L</namePart><namePart type="family">Houeto</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">V</namePart><namePart type="family">Mesnage</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A M</namePart><namePart type="family">Bonnet</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">V</namePart><namePart type="family">Czernecki</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D</namePart><namePart type="family">Maltête</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Hartmann</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L</namePart><namePart type="family">Mallet</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B</namePart><namePart type="family">Pidoux</namePart><affiliation>Service des Explorations Fonctionnelles Neurologiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D</namePart><namePart type="family">Dormont</namePart><affiliation>Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Navarro</namePart><affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Cornu</namePart><affiliation>Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Mallet</namePart><affiliation>Department of Biostatistics and Medical Information, Pitié-Salpêtrière Medical University, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Y</namePart><namePart type="family">Agid</namePart><affiliation>Centre d’Investigation Clinique, Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>Memory disorders (neurology)</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Drugs: CNS (not psychiatric)</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Parkinson's disease</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Ophthalmology</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Memory disorders (psychiatry)</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Mood disorders (including depression)</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2005-12</dateIssued><dateCreated encoding="w3cdtf">2005-11-16</dateCreated><copyrightDate encoding="w3cdtf">2005</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract 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.</abstract><note type="author-notes">Correspondence to:
Dr Y Agid
Centre d’Investigation Clinique, Hôpital de la Salpêtrière, 47 boulevard de l’Hôpital, 75013 Paris, France; yves.agid@psl.ap-hop-paris.fr</note><subject lang="en"><genre>ABR</genre><topic>ADL, activities of daily living</topic><topic>IQR, interquartile range</topic><topic>MADRS, Montgomery-Asberg Depression Rating Scale</topic><topic>PD, Parkinson’s disease</topic><topic>SD, standard deviations</topic><topic>STN, subthalamic nucleus</topic><topic>UPDRS, Unified Parkinson Disease Rating Scale</topic></subject><subject lang="en"><genre>KWD</genre><topic>Parkinson’s disease</topic><topic>stimulation</topic><topic>subthalamic nucleus</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>76</number></detail><detail type="issue"><caption>no.</caption><number>12</number></detail><extent unit="pages"><start>1640</start></extent></part></relatedItem><identifier type="istex">AFD26FC59AB3B41D892F2B19DE6D833F31BBD86B</identifier><identifier type="DOI">10.1136/jnnp.2005.063206</identifier><identifier type="href">jnnp-76-1640.pdf</identifier><identifier type="PMID">16291886</identifier><identifier type="local">0761640</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright 2005 Journal of Neurology Neurosurgery and Psychiatry</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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