• Parkinsonism Relat. Disord. · Apr 2014

    Clinical Trial

    Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: from the advanced phase towards the late stage of the disease?

    • M G Rizzone, A Fasano, A Daniele, M Zibetti, A Merola, L Rizzi, C Piano, C Piccininni, L M Romito, L Lopiano, and A Albanese.
    • University of Torino, 'Rita Levi Montalcini' Department of Neuroscience, Via Cherasco, 15, 10126 Torino, Italy.
    • Parkinsonism Relat. Disord. 2014 Apr 1; 20 (4): 376-81.

    BackgroundDeep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome.ObjectiveTo report the results of a long-term follow-up (mean 11 years, range 10-13) on 26 patients bilaterally implanted in two centres.MethodsPatients were assessed preoperatively and 1, 5 and 11 years after the implant by the Unified Parkinson's Disease Rating Scale (UPDRS) and a battery of neuropsychological tests. Stimulation parameters, drugs dosages, non-motor symptoms and adverse events were also recorded.ResultsAt 11 years, stimulation significantly improved the motor symptoms by 35.8%, as compared to the preoperative off-state. Motor complications were well controlled, with a 84.6% improvement of dyskinesias and a 65.8% improvement of motor fluctuations. Despite this, the UPDRS-II-on score worsened by 88.5%, mainly for the worsening of poorly levodopa-responsive symptoms. More than 70% of the patients performed in the normal range in most of the neuropsychological tests, despite the development of dementia in 22.7%. Age at disease onset, axial subscore in off-condition and presence of REM behaviour disorder at baseline were found to be associated with a higher risk of developing disability over time.ConclusionsOur study confirms the long-term safety and efficacy of STN-DBS in PD. Nevertheless, the functionality of patients worsens over time, mainly for the onset and progression of levodopa-resistant and non-motor symptoms. The role of PD-subtype seems to be relevant in the long-term outcome.Copyright © 2014 Elsevier Ltd. All rights reserved.

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