Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2005 Jan;76(1):34–39. doi: 10.1136/jnnp.2003.032623

Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease: target related effect or selection bias?

A Minguez-Castellan 1, F Escamilla-Sevilla 1, M Katati 1, J Martin-Linares 1, M Meersmans 1, A Ortega-Moreno 1, V Arjona 1
PMCID: PMC1739322  PMID: 15607992

Abstract

Background: Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is favoured over bilateral globus pallidus internus (Gpi) DBS for symptomatic treatment of advanced Parkinson's disease (PD) due to the possibility of reducing medication, despite lack of definitive comparative evidence.

Objective: To analyse outcomes after one year of bilateral Gpi or STN DBS, with consideration of influence of selection bias on the pattern of postsurgical medication change.

Methods: The first patients to undergo bilateral Gpi (n = 10) or STN (n = 10) DBS at our centre were studied. They were assessed presurgically and one year after surgery (CAPIT protocol).

Results: Before surgery the Gpi DBS group had more dyskinesias and received lower doses of medication. At one year, mean reduction in UPDRS off medication score was 35% and 39% in the Gpi and STN groups, respectively (non-significant difference). Dyskinesias reduced in proportion to presurgical severity. The levodopa equivalent dose was significantly reduced only in the STN group (24%). This study high-lights the absence of significant differences between the groups in clinical scales and medication dose at one year. In the multivariate analysis of predictive factors for off-state motor improvement, the presurgical levodopa equivalent dose showed a direct relation in the STN and an inverse relation in the Gpi group.

Conclusion: Differences in the patterns of medication change after Gpi and STN DBS may be partly due to a patient selection bias. Both procedures may be equally useful for different subgroups of patients with advanced PD, Gpi DBS especially for patients with lower threshold for dyskinesia.

Full Text

The Full Text of this article is available as a PDF (103.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Burchiel K. J., Anderson V. C., Favre J., Hammerstad J. P. Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: results of a randomized, blinded pilot study. Neurosurgery. 1999 Dec;45(6):1375–1384. doi: 10.1097/00006123-199912000-00024. [DOI] [PubMed] [Google Scholar]
  2. Figueiras-Méndez R., Regidor I., Riva-Meana C., Magariños-Ascone C. M. Further supporting evidence of beneficial subthalamic stimulation in Parkinson's patients. Neurology. 2002 Feb 12;58(3):469–470. doi: 10.1212/wnl.58.3.469. [DOI] [PubMed] [Google Scholar]
  3. Fraix V., Pollak P., Van Blercom N., Xie J., Krack P., Koudsie A., Benabid A. L. Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinson's disease. Neurology. 2000 Dec 26;55(12):1921–1923. doi: 10.1212/wnl.55.12.1921. [DOI] [PubMed] [Google Scholar]
  4. Houeto J. L., Mesnage V., Mallet L., Pillon B., Gargiulo M., du Moncel S. Tezenas, Bonnet A. M., Pidoux B., Dormont D., Cornu P. Behavioural disorders, Parkinson's disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry. 2002 Jun;72(6):701–707. doi: 10.1136/jnnp.72.6.701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Houeto J. L., Mesnage V., Welter M. L., Mallet L., Agid Y., Bejjani B. P. Subthalamic DBS replaces levodopa in Parkinson's disease: two-year follow-up. Neurology. 2003 Jan 14;60(1):154–155. [PubMed] [Google Scholar]
  6. Kleiner-Fisman Galit, Fisman David N., Sime Elspeth, Saint-Cyr Jean A., Lozano Andres M., Lang Anthony E. Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg. 2003 Sep;99(3):489–495. doi: 10.3171/jns.2003.99.3.0489. [DOI] [PubMed] [Google Scholar]
  7. Krack P., Pollak P., Limousin P., Hoffmann D., Xie J., Benazzouz A., Benabid A. L. Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease. Brain. 1998 Mar;121(Pt 3):451–457. doi: 10.1093/brain/121.3.451. [DOI] [PubMed] [Google Scholar]
  8. Krause M., Fogel W., Heck A., Hacke W., Bonsanto M., Trenkwalder C., Tronnier V. Deep brain stimulation for the treatment of Parkinson's disease: subthalamic nucleus versus globus pallidus internus. J Neurol Neurosurg Psychiatry. 2001 Apr;70(4):464–470. doi: 10.1136/jnnp.70.4.464. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kumar R., Lozano A. M., Sime E., Halket E., Lang A. E. Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation. Neurology. 1999 Aug 11;53(3):561–566. doi: 10.1212/wnl.53.3.561. [DOI] [PubMed] [Google Scholar]
  10. Lagrange E., Krack P., Moro E., Ardouin C., Van Blercom N., Chabardes S., Benabid A. L., Pollak P. Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD. Neurology. 2002 Dec 24;59(12):1976–1978. doi: 10.1212/01.wnl.0000037486.82390.1c. [DOI] [PubMed] [Google Scholar]
  11. Lang A. E., Kleiner-Fisman G., Saint-Cyr J. A., Miyasaki J., Lozano A. Subthalamic DBS replaces levodopa in Parkinson's disease: two-year follow-up. Neurology. 2003 Jan 14;60(1):154–155. [PubMed] [Google Scholar]
  12. Langston J. W., Widner H., Goetz C. G., Brooks D., Fahn S., Freeman T., Watts R. Core assessment program for intracerebral transplantations (CAPIT). Mov Disord. 1992;7(1):2–13. doi: 10.1002/mds.870070103. [DOI] [PubMed] [Google Scholar]
  13. Limousin P., Krack P., Pollak P., Benazzouz A., Ardouin C., Hoffmann D., Benabid A. L. Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med. 1998 Oct 15;339(16):1105–1111. doi: 10.1056/NEJM199810153391603. [DOI] [PubMed] [Google Scholar]
  14. Linazasoro G. Subthalamic deep brain stimulation for advanced Parkinson's disease: all that glitters is not gold. J Neurol Neurosurg Psychiatry. 2003 Jun;74(6):827–827. doi: 10.1136/jnnp.74.6.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Loher Thomas J., Burgunder Jean-Marc, Pohle Thomas, Weber Sabine, Sommerhalder Regine, Krauss Joachim K. Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1-year follow-up study. J Neurosurg. 2002 May;96(5):844–853. doi: 10.3171/jns.2002.96.5.0844. [DOI] [PubMed] [Google Scholar]
  16. Oh Michael Y., Abosch Aviva, Kim Seong H., Lang Anthony E., Lozano Andres M. Long-term hardware-related complications of deep brain stimulation. Neurosurgery. 2002 Jun;50(6):1268–1276. doi: 10.1097/00006123-200206000-00017. [DOI] [PubMed] [Google Scholar]
  17. Okun M. S., Green J., Saben R., Gross R., Foote K. D., Vitek J. L. Mood changes with deep brain stimulation of STN and GPi: results of a pilot study. J Neurol Neurosurg Psychiatry. 2003 Nov;74(11):1584–1586. doi: 10.1136/jnnp.74.11.1584. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pahwa Rajesh, Wilkinson Steven B., Overman John, Lyons Kelly E. Bilateral subthalamic stimulation in patients with Parkinson disease: long-term follow up. J Neurosurg. 2003 Jul;99(1):71–77. doi: 10.3171/jns.2003.99.1.0071. [DOI] [PubMed] [Google Scholar]
  19. Simuni Tanya, Jaggi Jurg L., Mulholland Heather, Hurtig Howard I., Colcher Amy, Siderowf Andrew D., Ravina Bernard, Skolnick Brett E., Goldstein Reid, Stern Matthew B. Bilateral stimulation of the subthalamic nucleus in patients with Parkinson disease: a study of efficacy and safety. J Neurosurg. 2002 Apr;96(4):666–672. doi: 10.3171/jns.2002.96.4.0666. [DOI] [PubMed] [Google Scholar]
  20. Tavella A., Bergamasco B., Bosticco E., Lanotte M., Perozzo P., Rizzone M., Torre E., Lopiano L. Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: long-term follow-up. Neurol Sci. 2002 Sep;23 (Suppl 2):S111–S112. doi: 10.1007/s100720200094. [DOI] [PubMed] [Google Scholar]
  21. Thobois S., Mertens P., Guenot M., Hermier M., Mollion H., Bouvard M., Chazot G., Broussolle E., Sindou M. Subthalamic nucleus stimulation in Parkinson's disease: clinical evaluation of 18 patients. J Neurol. 2002 May;249(5):529–534. doi: 10.1007/s004150200059. [DOI] [PubMed] [Google Scholar]
  22. Valldeoriola Francesc, Pilleri Manuela, Tolosa Eduardo, Molinuevo José L., Rumià Jordi, Ferrer Enric. Bilateral subthalamic stimulation monotherapy in advanced Parkinson's disease: long-term follow-up of patients. Mov Disord. 2002 Jan;17(1):125–132. doi: 10.1002/mds.1278. [DOI] [PubMed] [Google Scholar]
  23. Vesper J., Klostermann F., Stockhammer F., Funk Th, Brock M. Results of chronic subthalamic nucleus stimulation for Parkinson's disease: a 1-year follow-up study. Surg Neurol. 2002 May;57(5):306–313. doi: 10.1016/s0090-3019(02)00691-2. [DOI] [PubMed] [Google Scholar]
  24. Vingerhoets François J. G., Villemure J-G, Temperli P., Pollo C., Pralong E., Ghika J. Subthalamic DBS replaces levodopa in Parkinson's disease: two-year follow-up. Neurology. 2002 Feb 12;58(3):396–401. doi: 10.1212/wnl.58.3.396. [DOI] [PubMed] [Google Scholar]
  25. Vitek Jerrold L. Deep brain stimulation for Parkinson's disease. A critical re-evaluation of STN versus GPi DBS. Stereotact Funct Neurosurg. 2002;78(3-4):119–131. doi: 10.1159/000068959. [DOI] [PubMed] [Google Scholar]
  26. Volkmann J., Allert N., Voges J., Weiss P. H., Freund H. J., Sturm V. Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology. 2001 Feb 27;56(4):548–551. doi: 10.1212/wnl.56.4.548. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES