Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: Long‐term observation
Identifieur interne : 002D69 ( Main/Corpus ); précédent : 002D68; suivant : 002D70Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: Long‐term observation
Auteurs : Luigi M. Romito ; Maria Fiorella Contarino ; Nicola Vanacore ; Anna Rita Bentivoglio ; Massimo Scerrati ; Alberto AlbaneseSource :
- Movement Disorders [ 0885-3185 ] ; 2009-03-15.
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Abstract
Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long‐term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on‐period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long‐term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures. © 2008 Movement Disorder Society
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DOI: 10.1002/mds.22390
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ISTEX:587C5448CF1D3481A43F689010EF4069F596DF83Le document en format XML
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Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2009-03-15">2009-03-15</date><biblScope unit="volume">24</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="555">555</biblScope><biblScope unit="page" to="561">561</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">587C5448CF1D3481A43F689010EF4069F596DF83</idno><idno type="DOI">10.1002/mds.22390</idno><idno type="ArticleID">MDS22390</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>deep brain stimulation</term><term>dopamine agonists</term><term>levodopa</term><term>subthalamic nucleus</term><term>surgery</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long‐term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on‐period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long‐term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures. © 2008 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Luigi M. Romito MD, PhD</name><affiliations><json:string>Fondazione IRCCS Istituto Neurologico “Carlo Besta,” Milano, Italy</json:string><json:string>Università Cattolica del Sacro Cuore, Milano, Italy</json:string></affiliations></json:item><json:item><name>Maria Fiorella Contarino MD</name><affiliations><json:string>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italia</json:string></affiliations></json:item><json:item><name>Nicola Vanacore MD</name><affiliations><json:string>Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Roma, Italia</json:string></affiliations></json:item><json:item><name>Anna Rita Bentivoglio MD, PhD</name><affiliations><json:string>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italia</json:string></affiliations></json:item><json:item><name>Massimo Scerrati MD</name><affiliations><json:string>Clinica di Neurochirurgia, Università degli Studi, Ancona, Italy</json:string></affiliations></json:item><json:item><name>Alberto Albanese MD</name><affiliations><json:string>Fondazione IRCCS Istituto Neurologico “Carlo Besta,” Milano, Italy</json:string><json:string>Università Cattolica del Sacro Cuore, Milano, Italy</json:string></affiliations></json:item></author><subject><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>surgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>levodopa</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>dopamine agonists</value></json:item></subject><articleId><json:string>MDS22390</json:string></articleId><language><json:string>eng</json:string></language><abstract>Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long‐term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on‐period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long‐term at the expense of an increase of the total energy delivered. 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Celoria 11, I‐20133, Milano, Italy</p></note><affiliation>Fondazione IRCCS Istituto Neurologico “Carlo Besta,” Milano, Italy</affiliation><affiliation>Università Cattolica del Sacro Cuore, Milano, Italy</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. 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We performed a long‐term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on‐period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long‐term at the expense of an increase of the total energy delivered. 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We performed a long‐term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on‐period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long‐term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures. © 2008 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn7"><p>Potential conflict of interest: None reported.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: Long‐term observation</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Long‐Term Replacement of Dopaminergic Medication by STN DBS</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: Long‐term observation</title></titleInfo><name type="personal"><namePart type="given">Luigi M.</namePart><namePart type="family">Romito</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Fondazione IRCCS Istituto Neurologico “Carlo Besta,” Milano, Italy</affiliation><affiliation>Università Cattolica del Sacro Cuore, Milano, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Maria Fiorella</namePart><namePart type="family">Contarino</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Nicola</namePart><namePart type="family">Vanacore</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Roma, Italia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anna Rita</namePart><namePart type="family">Bentivoglio</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Massimo</namePart><namePart type="family">Scerrati</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Clinica di Neurochirurgia, Università degli Studi, Ancona, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alberto</namePart><namePart type="family">Albanese</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Fondazione IRCCS Istituto Neurologico “Carlo Besta,” Milano, Italy</affiliation><affiliation>Università Cattolica del Sacro Cuore, Milano, Italy</affiliation><description>Correspondence: Fondazione IRCCS, Istituto Neurologico “Carlo Besta”, Via G. Celoria 11, I‐20133, Milano, Italy</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2009-03-15</dateIssued><dateCaptured encoding="w3cdtf">2008-04-03</dateCaptured><dateValid encoding="w3cdtf">2008-10-19</dateValid><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">2</extent><extent unit="references">25</extent><extent unit="words">4976</extent></physicalDescription><abstract lang="en">Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long‐term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on‐period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long‐term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures. © 2008 Movement Disorder Society</abstract><note type="content">*Potential conflict of interest: None reported.</note><note type="funding">Italian Ministry of University and Research</note><note type="funding">National Interest Project - No. 2001062543; </note><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>surgery</topic><topic>deep brain stimulation</topic><topic>subthalamic nucleus</topic><topic>levodopa</topic><topic>dopamine agonists</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>24</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>555</start><end>561</end><total>7</total></extent></part></relatedItem><identifier type="istex">587C5448CF1D3481A43F689010EF4069F596DF83</identifier><identifier type="DOI">10.1002/mds.22390</identifier><identifier type="ArticleID">MDS22390</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2008 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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