This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (103)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Movement Disorders  • Parkinson Disease/ Parkinsonian Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

José L. Molinuevo, MD; Francesc Valldeoriola, MD; Eduardo Tolosa, MD; Jordi Rumià, MD; Josep Valls-Solé, MD; Héctor Roldán, MD; Enric Ferrer, MD

Arch Neurol. 2000;57:983-988.

Context  Subthalamic nucleus (STN) stimulation may be effective in ameliorating parkinsonian symptoms even to the extent to permit levodopa withdrawal.

Objectives  To analyze the efficacy of STN stimulation in patients with Parkinson disease (PD) and to determine if levodopa may be withdrawn after surgery.

Design  Before-after trial.

Setting  Referral center, hospitalized care.

Patients  Fifteen patients with advanced PD.

Interventions  Microelectrode-guided bilateral STN high-frequency stimulation.

Outcome Measures  Before surgery patients were evaluated in off-medication and on-medication conditions. Dopaminergic drug dosages were reduced after surgery, aiming for complete withdrawal. Six months after surgery, patients were reeavaluated in off- and on-medication conditions, with the stimulation turned on and off.

Results  Total Unified Parkinson's Disease Rating Scale (UPDRS) motor score in the off-medication condition improved by 65.9%; and axial symptoms, bradykinesia, rigidity, and tremor improved by 65.8%, 60.4%, 66.1%, and 81.1%, respectively. UPDRS part II scores were reduced by 71.8% and Schwab and England scores improved by 45.3%. Levodopa was withdrawn in 8 patients and the overall levodopa dose was reduced 80.4%. "Off" time was reduced 89.7% and the severity of dyskinesias decreased 80.6% after surgery. All results reached significance (P<.001). Stimulation of the STN achieved antiparkinsonian effect similar to that of treatment with levodopa. No life-threatening adverse effects occurred.

Conclusions  Bilateral STN stimulation safely improves all parkinsonian symptoms, decreases or eliminates the need for levodopa, and ameliorates motor fluctuations and dyskinesias. Complete withdrawal of levodopa is feasible with this technique and the overall motor effect of STN stimulation is quantitatively comparable to that obtained with levodopa.

From the Neurology Service (Drs Molinuevo, Valldeoriola, Tolosa, and Valls-Solé) and Neurosurgery Service (Drs Rumià, Roldán, and Ferrer), Institut Clínic de Malalties del Sistema Nerviós, Institut d'Investigations Biomédiques August Pi i Suñer (IDIBAPS), Hospital Clínic Universitari, Barcelona, Spain.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2000;57(7):1089-1090.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Parkinson's disease, DBS and suicide: a role for serotonin?
Temel et al.
Brain 2009;0:awp150v1-awp150.
FULL TEXT  

Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population?
Derost et al.
Neurology 2007;68:1345-1355.
ABSTRACT | FULL TEXT  

Subthalamic Stimulation in Parkinson Disease: Behavior and Social Adaptation.
Houeto et al.
Arch Neurol 2006;63:1090-1095.
ABSTRACT | FULL TEXT  

Bilateral subthalamotomy in Parkinson's disease: initial and long-term response
Alvarez et al.
Brain 2005;128:570-583.
ABSTRACT | FULL TEXT  

Subthalamic nucleus stimulation in advanced Parkinson's disease: blinded assessments at one year follow up
Ford et al.
J. Neurol. Neurosurg. Psychiatry 2004;75:1255-1259.
ABSTRACT | FULL TEXT  

Single Pulse Stimulation of the Human Subthalamic Nucleus Facilitates the Motor Cortex at Short Intervals
Hanajima et al.
J. Neurophysiol. 2004;92:1937-1943.
ABSTRACT | FULL TEXT  

Subthalamic nucleus stimulation modulates motor cortex oscillatory activity in Parkinson's disease
Devos et al.
Brain 2004;127:408-419.
ABSTRACT | FULL TEXT  

MRI directed bilateral stimulation of the subthalamic nucleus in patients with Parkinson's disease
Patel et al.
J. Neurol. Neurosurg. Psychiatry 2003;74:1631-1637.
ABSTRACT | FULL TEXT  

Effect of chronic bilateral subthalamic nucleus (STN) stimulation on postural control in Parkinson's disease
Maurer et al.
Brain 2003;126:1146-1163.
ABSTRACT | FULL TEXT  

Subthalamic Stimulation in Parkinson Disease: Intraoperative Predictive Factors
Houeto et al.
Arch Neurol 2003;60:690-694.
ABSTRACT | FULL TEXT  

Deep brain stimulation of the subthalamic nucleus: effectiveness in advanced Parkinson's disease patients previously reliant on apomorphine
Varma et al.
J. Neurol. Neurosurg. Psychiatry 2003;74:170-174.
ABSTRACT | FULL TEXT  

Response to levodopa in parkinsonian patients with bilateral subthalamic nucleus stimulation
Moro et al.
Brain 2002;125:2408-2417.
ABSTRACT | FULL TEXT  

Behavioural disorders, Parkinson's disease and subthalamic stimulation
Houeto et al.
J. Neurol. Neurosurg. Psychiatry 2002;72:701-707.
ABSTRACT | FULL TEXT  

Sleep symptoms and polysomnographic architecture in advanced Parkinson's disease after chronic bilateral subthalamic stimulation
Iranzo et al.
J. Neurol. Neurosurg. Psychiatry 2002;72:661-664.
ABSTRACT | FULL TEXT  

Clinical predictive factors of subthalamic stimulation in Parkinson's disease
Welter et al.
Brain 2002;125:575-583.
ABSTRACT | FULL TEXT  

Subthalamic DBS replaces levodopa in Parkinson's disease: Two-year follow-up
Vingerhoets et al.
Neurology 2002;58:396-401.
ABSTRACT | FULL TEXT  

Effects of Bilateral Subthalamic Stimulation on Cognitive Function in Parkinson Disease
Alegret et al.
Arch Neurol 2001;58:1223-1227.
ABSTRACT | FULL TEXT  

The subthalamic nucleus, hemiballismus and Parkinson's disease: reappraisal of a neurosurgical dogma
Guridi and Obeso
Brain 2001;124:5-19.
ABSTRACT | FULL TEXT