Abstract
Objective. To evaluate the efficacy of deep brain stimulation of the subthalamic nucleus (STN DBS) in patients with Parkinson disease (PD) who previously underwent lesioning of the basal ganglia. Material and methods. The study included 22 patients who underwent STN DBS. Eleven patients had undergone prior unilateral pallidotomy (n = 6) or VL/VIM thalamotomy (n = 5) while the other 11 patients had not. The primary outcome was the change from baseline in the motor subscore of the Unified Parkinson Disease Rating Scale (UPDRS-III) 12 months after STN DBS. Secondary outcomes included change in motor response complications (UPDRS-IV) and change in levodopa equivalent daily dose (LEDD). Results. In the group with prior lesioning UPDRS-III improved by 45%, from 51.5 ± 9.0% (range, 35–65) to 26.5 ± 8.4 (range, 21–50) (p < 0.01) and UPDRS-IV by 75%, from 8.0 ± 2.01 (range, 5–11) to 2.1 ± 0.74 (range, 1–3) (p < 0.01). In the group without prior lesioning UPDRS-III improved by 61%, from 74.2% ± 7.32 (range, 63–82) to 29.3 ± 5.99 (range, 20–42) (p < 0.01) and UPDRS-IV by 77%, from 9.1 ± 2.46 (range, 5–12) to 2.0 ± 1.1 (range, 1–4) (p < 0.01). Comparing the two groups (with and without lesioning) no significant differences were found either in UPDRS-III (p > 0.05) or UPDRS-IV scores (p > 0.05) at 12 months post-DBS. The LEDD was reduced by 51.4%, from 1008.2 ± 346.4 to 490.0 ± 194.3 in those with prior surgery (p < 0.01) and by 55.0%, from 963.4 ± 96.2 to 433.3 ± 160.2 in those without (p < 0.01).UPDRS-III improved by 51.8%, from 53.7 ± 4.6 (range, 50–62) to 25.0 ± 3.8 (range, 21–31) in those with prior pallidotomy (p < 0.01), and by 37.5%, from 48.8 ± 12.6 (range, 35–65) to 29.8 ± 13.6 (range, 22–50) in those with prior thalamotomy (p < 0.01). This numerical difference in improvement was not statistically significant (p > 0.05). Conclusion. Our comparative study indicates that bilateral STN DBS is effective and can be used in patients with Parkinson disease with prior unilateral stereotactic destructive operations on subcortical structures. The results in our patient cohort are generally consistent with previously published reports of smaller series from multiple centers worldwide.
Highlights
Idiopathic Parkinson disease (PD) is the second most common neurodegenerative disease [1]
While deep brain stimulation is the preferred treatment in many countries, lesioning procedures such as pallidotomy and thalamotomy are still relevant, especially in areas where DBS is not available or not covered by health insurance
We report our experience with STN DBS in PD patients who had prior lesional procedures and compare their outcomes with those of PD patients who did not have previous destructive surgery
Summary
Idiopathic Parkinson disease (PD) is the second most common neurodegenerative disease (afterAlzheimer disease) [1]. Dopaminergic therapy is effective for the motor symptoms of PD, after 5 years. Brain Sci. 2018, 8, 66 of levodopa therapy more than 50% of patients develop motor response fluctuations while the risk of drug-induced dyskinesias increases every year by 10% [2]. While deep brain stimulation is the preferred treatment in many countries, lesioning procedures such as pallidotomy and thalamotomy are still relevant, especially in areas where DBS is not available or not covered by health insurance. Unilateral pallidotomy and thalamotomy effectively reduce contralateral parkinsonian symptoms but bilateral lesional procedures have been reported to be associated with significant side effects. STN DBS is known to improve all cardinal symptoms of PD, including tremor, bradykinesia and rigidity and improve quality of life of patients with advanced as well as moderate PD [5]. The effectiveness of STN DBS after destructive interventions is insufficiently studied
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