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Here's an abstract of the article from the NEJM. the url is: http://www.nejm.org/content/index.asp ---------------------------------------------------------------------------- ---- The New England Journal of Medicine -- October 15, 1998 -- Volume 339, Number 16 Electrical Stimulation of the Subthalamic Nucleus in Advanced Parkinson's Disease Patricia Limousin, Paul Krack, Pierre Pollak, Abdelhamid Benazzouz, Claire Ardouin, Dominique Hoffmann, Alim-Louis Benabid ---------------------------------------------------------------------------- ---- Abstract Background. In many patients with idiopathic Parkinson's disease, treatment with levodopa is complicated by fluctuations between an "off" period (also referred to as "off medication"), when the medication is not working and the motor symptoms of parkinsonism are present, and an "on" period, when the medication is causing improved mobility (also referred to as "on medication"), often accompanied by debilitating dyskinesias. In animal models of Parkinson's disease, there is overactivity in the subthalamic nucleus, and electrical stimulation of the subthalamic nucleus improves parkinsonism. We therefore sought to determine the efficacy and safety of electrical stimulation of the subthalamic nucleus in patients with Parkinson's disease. Methods. We studied 24 patients with idiopathic Parkinson's disease in whom electrodes were implanted bilaterally in the subthalamic nucleus under stereotactic guidance with imaging and electrophysiologic testing of the location. Twenty were followed for at least 12 months. Clinical evaluations included the Unified Parkinson's Disease Rating Scale, a dyskinesia scale, and timed tests conducted before and after surgery, when patients were off and on medications. Results. After one year of electrical stimulation of the subthalamic nucleus, the patients' scores for activities of daily living and motor examination scores (Unified Parkinson's Disease Rating Scale parts II and III, respectively) off medication improved by 60 percent (P<0.001). The subscores improved for limb akinesia, rigidity, tremor, and gait. In the testing done on medication, the scores on part III improved by 10 percent (P<0.005). The mean dose of dopaminergic drugs was reduced by half. The cognitive-performance scores remained unchanged, but one patient had paralysis and aphasia after an intracerebral hematoma during the implantation procedure. Conclusions. Electrical stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease. The severity of symptoms off medication decreases, and the dose of levodopa can be reduced, with a consequent reduction in dyskinesias. (N Engl J Med 1998;339:1105-11.) Source Information From the Department of Clinical and Biologic Neurosciences, Joseph Fourier University, Grenoble, France (P.L., P.K., P.P., A.B., C.A., D.H., A.-L.B.); the Medical Research Council Human Movement and Balance Unit, Queen Square, London (P.L.); and the Neurology Department, University of Kiel, Kiel, Germany (P.K.). Address reprint requests to Dr. Pollak at the Department of Clinical and Biologic Neurosciences, Joseph Fourier University, B.P. 217, 38043 Grenoble CEDEX 9, France. ---------------------------------------------------------------------------- ---- The full text of Original Articles is available to subscribers only after logging on. However, you can order the complete article. ---------------------------------------------------------------------------- ---- Table of Contents | Previous Article | Next Article ---------------------------------------------------------------------------- ---- Copyright © 1998 by the Massachusetts Medical Society. All rights reserved.