Detalle Publicación

ARTÍCULO
Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease
Autores: Moro, E; Lozano, AM; Pollack, P; Agid, Y; Rehncrona, S; Volkmann, J; Kulisevsky, J; Obeso Inchausti, José Ángel; Albanese, A; Hariz, MI; Quinn, NP; Speelman, JD; Benavid, AL; Fraix, V; Mendes, A; Welter, ML; Houeto, JL; Cornu, P; Dormont, D; Torngvist, AL; Ekberg, R; Schnitzler, A; Timmermann, L; Wojtecki, L; Gironell, A; Rodríguez Oroz, María Cruz; Guridi Legarra, Jorge; Bentivoglio, AR; Contarino, MF; Romito, L; Scerrati, M; Janssens M, M; Lang, AE
Título de la revista: Movement Disorders
ISSN: 0885-3185
Volumen: 25
Número: 5
Páginas: 578 - 586
Fecha de publicación: 2010
Resumen:
We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-five STN patients and 16 GPi patients were assessed at 5 to 6 years after DBS surgery. Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN, P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with off-stimulation, regardless of the sequence of stimulation. In open assessment, both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN, P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group. These results confirm the long-term efficacy of STN and GPi DBS in advanced PD. Although the surgical targets were not randomized, there was a trend to a better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group.