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Arch Neurol. 2000 Apr;57(4):461-5.

Subthalamic stimulation in Parkinson disease: a multidisciplinary approach.

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1
Centre d'Investigation Clinique, Fédération de Neurologie and Institut National de la Santé et de la Recherche Médicale, Unit 289, Paris, France.

Abstract

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.

PMID:
10768618
[Indexed for MEDLINE]
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