Bilateral subthalamotomy in Parkinson's disease: initial and long-term response
Identifieur interne : 001530 ( Main/Exploration ); précédent : 001529; suivant : 001531Bilateral subthalamotomy in Parkinson's disease: initial and long-term response
Auteurs : L. Alvarez ; R. Macias ; G. Lopez ; E. Alvarez ; N. Pavon ; M. C. Rodriguez-Oroz ; J. L. Juncos ; C. Maragoto ; J. Guridi ; I. Litvan ; E. S. Tolosa ; W. Koller [États-Unis] ; J. Vitek ; M. R. Delong ; J. A. ObesoSource :
- Brain [ 0006-8950 ] ; 2005-03.
English descriptors
- KwdEn :
- ADL = activities of daily living, CAPIT = Core Assessment Program for Intracerebral Transplantation, DBS = deep brain stimulation, FAB = Frontal Assessment Battery, GPi = globus pallidum pars interna, LID = levodopa-induced dyskinesia, MDRS = Mattis Dementia Rating Scale, MMSE = Mini-Mental Status Examination, NPI = neuropsychiatric inventory, Parkinson's disease, STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale, WAIS = Wechsler Adult Intelligence, WCST = Wisconsin Card Sorting Test, motor complications, subthalamic nucleus, subthalamotomy, surgery.
Abstract
We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.
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DOI: 10.1093/brain/awh397
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A." last="Obeso">J. A. Obeso</name><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation><affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-03">2005-03</date><biblScope unit="volume">128</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="570">570</biblScope><biblScope unit="page" to="583">583</biblScope></imprint><idno type="ISSN">0006-8950</idno></series><idno type="istex">2A5702D5F9D6DC83FF859E37CE6870D2264D3F04</idno><idno type="DOI">10.1093/brain/awh397</idno><idno type="local">awh397</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ADL = activities of daily living</term><term>CAPIT = Core Assessment Program for Intracerebral Transplantation</term><term>DBS = deep brain stimulation</term><term>FAB = Frontal Assessment Battery</term><term>GPi = globus pallidum pars interna</term><term>LID = levodopa-induced dyskinesia</term><term>MDRS = Mattis Dementia Rating Scale</term><term>MMSE = Mini-Mental Status Examination</term><term>NPI = neuropsychiatric inventory</term><term>Parkinson's disease</term><term>STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale</term><term>WAIS = Wechsler Adult Intelligence</term><term>WCST = Wisconsin Card Sorting Test</term><term>motor complications</term><term>subthalamic nucleus</term><term>subthalamotomy</term><term>surgery</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>État de New York</li></region></list><tree><noCountry><name sortKey="Alvarez, E" sort="Alvarez, E" uniqKey="Alvarez E" first="E." last="Alvarez">E. Alvarez</name><name sortKey="Alvarez, L" sort="Alvarez, L" uniqKey="Alvarez L" first="L." last="Alvarez">L. Alvarez</name><name sortKey="Delong, M R" sort="Delong, M R" uniqKey="Delong M" first="M. R." last="Delong">M. R. Delong</name><name sortKey="Guridi, J" sort="Guridi, J" uniqKey="Guridi J" first="J." last="Guridi">J. Guridi</name><name sortKey="Juncos, J L" sort="Juncos, J L" uniqKey="Juncos J" first="J. L." last="Juncos">J. L. Juncos</name><name sortKey="Litvan, I" sort="Litvan, I" uniqKey="Litvan I" first="I." last="Litvan">I. Litvan</name><name sortKey="Lopez, G" sort="Lopez, G" uniqKey="Lopez G" first="G." last="Lopez">G. Lopez</name><name sortKey="Macias, R" sort="Macias, R" uniqKey="Macias R" first="R." last="Macias">R. Macias</name><name sortKey="Maragoto, C" sort="Maragoto, C" uniqKey="Maragoto C" first="C." last="Maragoto">C. Maragoto</name><name sortKey="Obeso, J A" sort="Obeso, J A" uniqKey="Obeso J" first="J. A." last="Obeso">J. A. Obeso</name><name sortKey="Pavon, N" sort="Pavon, N" uniqKey="Pavon N" first="N." last="Pavon">N. Pavon</name><name sortKey="Rodriguez Oroz, M C" sort="Rodriguez Oroz, M C" uniqKey="Rodriguez Oroz M" first="M. C." last="Rodriguez-Oroz">M. C. Rodriguez-Oroz</name><name sortKey="Tolosa, E S" sort="Tolosa, E S" uniqKey="Tolosa E" first="E. S." last="Tolosa">E. S. Tolosa</name><name sortKey="Vitek, J" sort="Vitek, J" uniqKey="Vitek J" first="J." last="Vitek">J. Vitek</name></noCountry><country name="États-Unis"><region name="État de New York"><name sortKey="Koller, W" sort="Koller, W" uniqKey="Koller W" first="W." last="Koller">W. Koller</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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