Brain Advance Access originally published online on June 23, 2005
Brain 2005 128(10):2240-2249; doi:10.1093/brain/awh571
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Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up
1 Department of Neurology and Neurosurgery, Clinica Universitaria and Medical School, University of Navarra and CIMA, Pamplona, Spain, 2 Division of Neurology, Toronto Western Hospital, Movement Disorders Clinic, Toronto, Canada, 3 Groupe Hospitalier Pitié-Salpetrière, Paris, 4 Service de Neurologie, University Hospital of Grenoble, France, 5 Neurosurgery Service, Lund University Hospital, Sweden, 6 Department of Neurology, Hospital de Sant Pau, Barcelona, Spain, 7 Istituto Nazionale Neurologico Carlo Besta and Università Cattolica, Milan, Italy, 8 Neurologische Klinik der Christian-Albrecht-Universität, Kiel, Germany, 9 Institute of Neurology, Queen Square, London, UK, 10 Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands and 11 Department of Neuroscience, Universitá Catttolica del Sacro Cuore, Rome, Italy
Correspondence to: Prof J. A. Obeso, Neurologia-Neurociencias, Clinica Universitaria, Facultad de Medicina, Avenida de Pio XII, 36, Pamplona, 31008, Spain E-mail: jobeso{at}unav.es
Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6–12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n = 49) or globus pallidus internus (GPi, n = 20) included in a multicentre study. Patients were assessed preoperatively and at 1 year and 3–4 years after surgery. The primary outcome measure was the change in the ‘off’ medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) at 3–4 years. Stimulation of the STN or GPi induced a significant improvement (50 and 39%; P < 0.0001) of the ‘off’ medication UPDRS-III score at 3–4 years with respect to baseline. Stimulation improved cardinal features and activities of daily living (ADL) (P < 0.0001 and P < 0.02 for STN and GPi, respectively) and prolonged the ‘on’ time spent with good mobility without dyskinesias (P < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P < 0.001). Comparison of the improvement induced by stimulation at 1 year with 3–4 years showed a significant worsening in the ‘on’ medication motor states of the UPDRS-III, ADL and gait in both STN and GPi groups, and speech and postural stability in the STN-treated group. Adverse events (AEs) included cognitive decline, speech difficulty, instability, gait disorders and depression. These were more common in patients treated with DBS of the STN. No patient abandoned treatment as a result of these side effects. This experience, which represents the first multicentre study assessing the long-term efficacy of either STN or GPi stimulation, shows a significant and substantial clinically important therapeutic benefit for at least 3–4 years in a large cohort of patients with severe Parkinson's disease.
Key Words: deep brain stimulation; globus pallidus pars interna; long-term effects; Parkinson's disease; subthalamic nucleus
Abbreviations: ADL = activities of daily living; AEs = adverse events; DBS = deep brain stimulation; GPi = globus pallidus pars interna; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale
Received February 4, 2005. Revised May 13, 2005. Accepted May 19, 2005.
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