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Publication Detail
Long-term outcome of subthalamic nucleus deep brain stimulation for Parkinson's disease using an MRI-guided and MRI-verified approach.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Journal Article
  • Authors:
    Aviles-Olmos I, Kefalopoulou Z, Tripoliti E, Candelario J, Akram H, Martinez-Torres I, Jahanshahi M, Foltynie T, Hariz M, Zrinzo L, Limousin P
  • Publication date:
    12/2014
  • Pagination:
    1419, 1425
  • Journal:
    J Neurol Neurosurg Psychiatry
  • Volume:
    85
  • Issue:
    12
  • Status:
    Published
  • Country:
    England
  • PII:
    jnnp-2013-306907
  • Language:
    eng
  • Keywords:
    NEUROSURGERY, PARKINSON'S DISEASE, Activities of Daily Living, Deep Brain Stimulation, Female, Humans, Luria-Nebraska Neuropsychological Battery, Magnetic Resonance Imaging, Interventional, Male, Middle Aged, Parkinson Disease, Severity of Illness Index, Thalamus, Treatment Outcome
Abstract
BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) represents a well-established treatment for patients with advanced Parkinson's disease (PD) insufficiently controlled with medical therapies. This study presents the long-term outcomes of patients with PD treated with STN-DBS using an MRI-guided/MRI-verified approach without microelectrode recording. METHODS: A cohort of 41 patients who underwent STN-DBS were followed for a minimum period of 5 years, with a subgroup of 12 patients being followed for 8-11 years. Motor status was evaluated using part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III), in on- and off-medication/on-stimulation conditions. Preoperative and postoperative assessments further included activities of daily living (UPDRS-II), motor complications (UPDRS-IV), neuropsychological and speech assessments, as well as evaluation of quality of life. Active contacts localisation was calculated and compared with clinical outcomes. RESULTS: STN-DBS significantly improved the off-medication UPDRS-III scores, compared with baseline. However, UPDRS scores increased over time after DBS. Dyskinesias, motor fluctuations and demands in dopaminergic medication remained significantly reduced in the long term. Conversely, UPDRS-III on-medication scores deteriorated at 5 and 8 years, mostly driven by axial and bradykinesia subscores. Quality of life, as well as depression and anxiety scores, did not significantly change at long-term follow-up compared with baseline. In our series, severe cognitive decline was observed in 17.1% and 16.7% of the patients at 5 and 8 years respectively. CONCLUSIONS: Our data confirm that STN-DBS, using an MRI-guided/MRI-verified technique, remains an effective treatment for motor 'off' symptoms of PD in the long term with low morbidity.
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Clinical and Movement Neurosciences
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Department of Neuromuscular Diseases
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UCL Queen Square Institute of Neurology
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Clinical and Movement Neurosciences
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Clinical and Movement Neurosciences
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