Abstract
Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients.Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded.Results: The mean age at disease onset was 42.31 ± 7.29 years [28–58] and the mean age at surgery was 54.66 ± 8.51 years [34–70]. The median disease duration was 11.95 ± 4.28 years [5–22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases).Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.
Highlights
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson’s disease
Inclusion criteria for pre-operative assessment were diagnosis of Parkinson’s disease (PD) according to the UK Brain Bank Criteria [24], age under 70 years old, severe parkinsonian motor symptoms or dyskinesia that limit activities of daily living despite optimal medical therapy for at least 6 months, no dementia or major general illness
Global cognitive functioning was evaluated by the Mattis Dementia Rating Scales (MDRS) [25, 26] and the Montreal Cognitive Assessment (MoCA) [26, 27], intellectual capacities by the Progressive Matrices de Raven (PM47) [26, 28], executive functions by the Trail Making Test (TMT), Stroop test and Frontal Assessment Battery (FAB), memory by the verbal fluency and the Memory Impairment Screen (MIS-D), visual and constructive abilities by the Rey figure and the Benton Visual Retention Test [26].We considered a score of MDRS lower than 130/144 a cut off for DBS eligibility as well as severe executive troubles
Summary
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson’s disease. Stereotactic surgery represents a highly effective therapy for the treatment of Parkinson’s disease (PD) and other movement disorders refractory to medical treatment. The use of deep brain stimulation (DBS) for PD was driven by advances in the understanding of the pathophysiology and availability of animal models of the disease. In 1993, Benazzouz et al [1] successfully performed high frequency stimulation of the subthalamic nucleus (STN) in Macaca mulatta monkeys rendered parkinsonian by MPTP (1-methyl-4phenyl1,2,3,6-tetrahydropyridine).The authors have reported dramatic improvements of the motor symptoms without the development of abnormal involuntary movements. In 1994, Benabid et al [2] and Siegfried and Lippitz [3] reported successful treatment of patients with PD who underwent DBS of the subthalamic nucleus (STN) and of the globus pallidus internus (GPi), respectively. DBS in its current form is a symptomatic treatment that does not interfere with the progression of the disease, and does not affect the non-levodopa responsive motor and non-motor aspects of the disorder such as levodopa-refractory freezing of gait and balance problems nor non-motor aspects of the disease [4]
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