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A Multidisciplinary Approach

J. L. Houeto, MD; P. Damier, MD, PhD; P. B. Bejjani, MD; C. Staedler, MD; A. M. Bonnet, MD; I. Arnulf, MD; B. Pidoux, MD, PhD; D. Dormont, MD; P. Cornu, MD; Y. Agid, MD, PhD

Arch Neurol. 2000;57:461-465.

Background  High-frequency stimulation of the subthalamic nucleus constitutes a therapeutic advance for severely disabled patients with Parkinson disease.

Objective  To evaluate the efficacy and safety of continuous bilateral high-frequency stimulation of the subthalamic nucleus in patients with Parkinson disease.

Design  A prospective study of patients with Parkinson disease treated at a university hospital.

Patients and Methods  Electrodes were implanted bilaterally in the subthalamic nucleus of 23 consecutive patients with Parkinson disease who responded well to levodopa but had severe motor complications. There were 16 men and 7 women (mean ± SEM age, 53 ± 2 years) who had a mean ± SEM disease duration of 14.7 ± 1.0 years. Targets were determined by 3-dimensional magnetic resonance imaging, combined with intraoperative electrophysiologic recordings and stimulation.

Results  Six months after surgery, motor disability, levodopa-induced motor fluctuations, dyskinesias, and the daily dose of levodopa equivalent decreased significantly by 67%, 78%, 77%, and 61%, respectively, compared with the preoperative state. No significant morbidity was observed, except transient depression in 4 patients.

Conclusions  The beneficial effects of subthalamic stimulation depend on (1) the criteria used for patient selection, (2) the precision with which the subthalamic nucleus is targeted (dependent on the 3-dimensional magnetic resonance imaging and the intraoperative electrophysiologic and clinical assessments), and (3) the long-term postoperative adjustment of stimulation variables.

From the Centre d'Investigation Clinique, Fédération de Neurologie and Institut National de la Santé et de la Recherche Médicale, Unit 289 (Drs Houeto, Damier, Bejjani, Staedler, Bonnet, Arnulf, and Agid); and the Services d'Exploration Fonctionnelle Neurologique (Dr Pidoux), de Neuroradiologie (Dr Dormont), and de Neurochirurgie (Dr Cornu), Groupe Hospitalier Pitie-Salpêtrière, Paris, France.

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