Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2005 Dec;76(12):1640–1644. doi: 10.1136/jnnp.2005.063206

Stimulation of the subthalamic nucleus in Parkinson's disease: a 5 year follow up

W Schupbach 1, N Chastan 1, M Welter 1, J Houeto 1, V Mesnage 1, A Bonnet 1, V Czernecki 1, D Maltete 1, A Hartmann 1, L Mallet 1, B Pidoux 1, D Dormont 1, S Navarro 1, P Cornu 1, A Mallet 1, Y Agid 1
PMCID: PMC1739461  PMID: 16291886

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.

Full Text

The Full Text of this article is available as a PDF (70.1 KB).

Selected References

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

  1. Agid Y. Parkinson's disease: pathophysiology. Lancet. 1991 Jun 1;337(8753):1321–1324. doi: 10.1016/0140-6736(91)92989-f. [DOI] [PubMed] [Google Scholar]
  2. Barichella Michela, Marczewska Agnieszka M., Mariani Claudio, Landi Andrea, Vairo Antonella, Pezzoli Gianni. Body weight gain rate in patients with Parkinson's disease and deep brain stimulation. Mov Disord. 2003 Nov;18(11):1337–1340. doi: 10.1002/mds.10543. [DOI] [PubMed] [Google Scholar]
  3. Bejjani B. P., Dormont D., Pidoux B., Yelnik J., Damier P., Arnulf I., Bonnet A. M., Marsault C., Agid Y., Philippon J. Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg. 2000 Apr;92(4):615–625. doi: 10.3171/jns.2000.92.4.0615. [DOI] [PubMed] [Google Scholar]
  4. Bonnet A. M., Loria Y., Saint-Hilaire M. H., Lhermitte F., Agid Y. Does long-term aggravation of Parkinson's disease result from nondopaminergic lesions? Neurology. 1987 Sep;37(9):1539–1542. doi: 10.1212/wnl.37.9.1539. [DOI] [PubMed] [Google Scholar]
  5. Breit Sorin, Schulz Jörg B., Benabid Alim-Louis. Deep brain stimulation. Cell Tissue Res. 2004 Aug 19;318(1):275–288. doi: 10.1007/s00441-004-0936-0. [DOI] [PubMed] [Google Scholar]
  6. Broggi G., Franzini A., Ferroli P., Servello D., D'Incerti L., Genitrini S., Soliveri P., Girotti F., Caraceni T. Effect of bilateral subthalamic electrical stimulation in Parkinson's disease. Surg Neurol. 2001 Aug;56(2):89–96. doi: 10.1016/s0090-3019(01)00533-x. [DOI] [PubMed] [Google Scholar]
  7. Defer G. L., Widner H., Marié R. M., Rémy P., Levivier M. Core assessment program for surgical interventional therapies in Parkinson's disease (CAPSIT-PD). Mov Disord. 1999 Jul;14(4):572–584. doi: 10.1002/1531-8257(199907)14:4<572::aid-mds1005>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  8. Ford B., Winfield L., Pullman S. L., Frucht S. J., Du Y., Greene P., Cheringal J. H., Yu Q., Cote L. J., Fahn S. Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year follow up. J Neurol Neurosurg Psychiatry. 2004 Sep;75(9):1255–1259. doi: 10.1136/jnnp.2003.027557. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Funkiewiez A., Ardouin C., Caputo E., Krack P., Fraix V., Klinger H., Chabardes S., Foote K., Benabid A-L, Pollak P. Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson's disease. J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):834–839. doi: 10.1136/jnnp.2002.009803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hoehn M. M., Yahr M. D. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427–442. doi: 10.1212/wnl.17.5.427. [DOI] [PubMed] [Google Scholar]
  11. Houeto J. L., Damier P., Bejjani P. B., Staedler C., Bonnet A. M., Arnulf I., Pidoux B., Dormont D., Cornu P., Agid Y. Subthalamic stimulation in Parkinson disease: a multidisciplinary approach. Arch Neurol. 2000 Apr;57(4):461–465. doi: 10.1001/archneur.57.4.461. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Houeto Jean-Luc, Welter Marie-Laure, Bejjani Paul-Boulos, Tezenas du Montcel Sophie, Bonnet Anne-Marie, Mesnage Valerie, Navarro Soledad, Pidoux Bernard, Dormont Didier, Cornu Philippe. Subthalamic stimulation in Parkinson disease: intraoperative predictive factors. Arch Neurol. 2003 May;60(5):690–694. doi: 10.1001/archneur.60.5.690. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. Krack Paul, Batir Alina, Van Blercom Nadège, Chabardes Stephan, Fraix Valérie, Ardouin Claire, Koudsie Adnan, Limousin Patricia Dowsey, Benazzouz Abdelhamid, LeBas Jean François. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med. 2003 Nov 13;349(20):1925–1934. doi: 10.1056/NEJMoa035275. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. 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]
  18. Limousin P., Pollak P., Benazzouz A., Hoffmann D., Le Bas J. F., Broussolle E., Perret J. E., Benabid A. L. Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet. 1995 Jan 14;345(8942):91–95. doi: 10.1016/s0140-6736(95)90062-4. [DOI] [PubMed] [Google Scholar]
  19. Maesawa Satoshi, Kaneoke Yoshiki, Kajita Yasukazu, Usui Naotaka, Misawa Nobuaki, Nakayama Atsuo, Yoshida Jun. Long-term stimulation of the subthalamic nucleus in hemiparkinsonian rats: neuroprotection of dopaminergic neurons. J Neurosurg. 2004 Apr;100(4):679–687. doi: 10.3171/jns.2004.100.4.0679. [DOI] [PubMed] [Google Scholar]
  20. Montgomery S. A., Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979 Apr;134:382–389. doi: 10.1192/bjp.134.4.382. [DOI] [PubMed] [Google Scholar]
  21. Pillon B., Dubois B., Lhermitte F., Agid Y. Heterogeneity of cognitive impairment in progressive supranuclear palsy, Parkinson's disease, and Alzheimer's disease. Neurology. 1986 Sep;36(9):1179–1185. doi: 10.1212/wnl.36.9.1179. [DOI] [PubMed] [Google Scholar]
  22. RICKHAM P. P. HUMAN EXPERIMENTATION. CODE OF ETHICS OF THE WORLD MEDICAL ASSOCIATION. DECLARATION OF HELSINKI. Br Med J. 1964 Jul 18;2(5402):177–177. doi: 10.1136/bmj.2.5402.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Schmidt R., Freidl W., Fazekas F., Reinhart B., Grieshofer P., Koch M., Eber B., Schumacher M., Polmin K., Lechner H. The Mattis Dementia Rating Scale: normative data from 1,001 healthy volunteers. Neurology. 1994 May;44(5):964–966. doi: 10.1212/wnl.44.5.964. [DOI] [PubMed] [Google Scholar]
  24. Schrag A., Jahanshahi M., Quinn N. What contributes to quality of life in patients with Parkinson's disease? J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):308–312. doi: 10.1136/jnnp.69.3.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Schrag A., Quinn N. Dyskinesias and motor fluctuations in Parkinson's disease. A community-based study. Brain. 2000 Nov;123(Pt 11):2297–2305. doi: 10.1093/brain/123.11.2297. [DOI] [PubMed] [Google Scholar]
  26. Temperli P., Ghika J., Villemure J-G, Burkhard P. R., Bogousslavsky J., Vingerhoets F. J. G. How do parkinsonian signs return after discontinuation of subthalamic DBS? Neurology. 2003 Jan 14;60(1):78–81. doi: 10.1212/wnl.60.1.78. [DOI] [PubMed] [Google Scholar]
  27. Welter M. L., Houeto J. L., Tezenas du Montcel S., Mesnage V., Bonnet A. M., Pillon B., Arnulf I., Pidoux B., Dormont D., Cornu P. Clinical predictive factors of subthalamic stimulation in Parkinson's disease. Brain. 2002 Mar;125(Pt 3):575–583. doi: 10.1093/brain/awf050. [DOI] [PubMed] [Google Scholar]

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

RESOURCES