N Engl J Med 1998 Oct 15;339(16):1105-1111
Electrical Stimulation of the Subthalamic Nucleus in Advanced
Parkinson's Disease.
Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D,
Benabid AL
Department of Clinical and Biologic Neurosciences, Joseph Fourier
University, B.P. 217, 38043 Grenoble CEDEX 9, France.
[Record supplied by publisher]
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.
PMID: 9770557
--
Judith Richards, London, Ontario, Canada
<[log in to unmask]>
^^^
\ /
\ | / Today’s Research
\\ | // ...Tomorrow’s Cure
\ | /
\|/
```````
