Abstract
Background and purpose: Subthalamic nucleus deep brain stimulation (STN DBS) is well established for the treatment of advanced Parkinson’s disease (PD), substantially improving motor symptoms, quality of life, and reducing the long-term need for dopaminergic medication. However, whether chronic STN DBS produces different effects on PD motor subtypes is unknown. This retrospective study aimed to evaluate the long-term effects of STN DBS on the PD motor subtypes.Methods: Eighty patients undergoing STN DBS were included. The Unified Parkinson’s Disease Rating Scale (UPDRS) analysis was performed in “On” and “Off” medication/“On” and “Off” stimulation conditions. The patients were classified as akinetic-rigid type (ART), tremor-dominant type (TDT), and mixed type (MT) based on the preoperative UPDRS III subscores in the “Off” medication state. Preoperative and postoperative comparisons were performed.Results: After 4.9 years, STN DBS produced significant improvement in the UPDRS III total scores and subscores of tremor, rigidity, and bradykinesia in the “Off” medication state in the ART group, less improvement in the MT group, and the least improvement in the TDT group. The UPDRS II and III total scores and other subscores failed to improve during the “On” medication state. However, all groups improved substantially, and the improvement in tremor was sustained for both the “On” and “Off” medication states after years. Long-term STN DBS failed to improve swallowing and speech in all the subtypes.Conclusion: The data confirms that PD is heterogeneous. Long-term STN DBS produced the best effects on bradykinesia/rigidity in the “Off” medication state and on tremor in the “On” and “Off” medication states. There were differences in the response by each group, but some of the differences could be explained by the fact that more severe symptoms at baseline tend to have greater improvement. The findings support the idea that ART mainly involves the basal ganglia-thalamo-cortical pathway, whereas TDT involves a different circuit, likely the cerebellar-thalamo-cortical pathway.
Highlights
The akinetic-rigid type (ART) group presented the highest scores among the three groups
Further analysis of the Unified Parkinson’s disease Rating Scale (UPDRS) scores and subscores showed that Subthalamic nucleus deep brain stimulation (STN DBS) produced significant and persistent effects on the ART and mixed type (MT) groups as compared with the tremor-dominant type (TDT) group
For the ART group, improvements were seen in the UPDRS III: total score = 46.6%; tremor = 80.6%; rigidity = 47.4%; bradykinesia = 45.3%; axial rigidity = 44.6%; gait = 44.8%; and postural stability = 56.0% (p < 0.001–0.007)
Summary
Subthalamic nucleus deep brain stimulation (STN DBS) is well established for the treatment of advanced Parkinson’s disease (PD), substantially improving motor symptoms, quality of life, and reducing the long-term requirement of dopaminergic medication (Krack et al, 2003; Deuschl et al, 2006; Benabid et al, 2009; Gervais-Bernard et al, 2009; Volkmann et al, 2009; Aviles-Olmos et al, 2014).Parkinson’s disease is heterogeneous and can be classified into different subtypes (Hughes et al, 1992; Zaidel et al, 2009). Subthalamic nucleus deep brain stimulation (STN DBS) is well established for the treatment of advanced Parkinson’s disease (PD), substantially improving motor symptoms, quality of life, and reducing the long-term requirement of dopaminergic medication (Krack et al, 2003; Deuschl et al, 2006; Benabid et al, 2009; Gervais-Bernard et al, 2009; Volkmann et al, 2009; Aviles-Olmos et al, 2014). Long-term follow-up studies have demonstrated that parkinsonian symptoms respond variably to STN stimulation, showing improvement for some symptoms and deterioration for others (Rizzone et al, 2014) These studies mainly focused on the effects of STN DBS for PD motor symptoms, medication consumption, or other complications. Subthalamic nucleus deep brain stimulation (STN DBS) is well established for the treatment of advanced Parkinson’s disease (PD), substantially improving motor symptoms, quality of life, and reducing the long-term need for dopaminergic medication. This retrospective study aimed to evaluate the long-term effects of STN DBS on the PD motor subtypes
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