Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the recent surgical treatment of choice for patients with idiopathic Parkinson's disease (PD) complicated by motor fluctuation and disabling dyskinesia. Objective: To study 2 years clinical outcomes, changes of medicatio...

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Main Authors: Sarun Nunta-Aree, Bunpot Sitthinamsuwan, Kanokwan Boonyapisit, Apichart Pisarnpong
Other Authors: Mahidol University
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Published: 2018
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Online Access:https://repository.li.mahidol.ac.th/handle/123456789/29676
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spelling th-mahidol.296762018-09-24T16:28:55Z Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease Sarun Nunta-Aree Bunpot Sitthinamsuwan Kanokwan Boonyapisit Apichart Pisarnpong Mahidol University Medicine Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the recent surgical treatment of choice for patients with idiopathic Parkinson's disease (PD) complicated by motor fluctuation and disabling dyskinesia. Objective: To study 2 years clinical outcomes, changes of medication and complications following STN-DBS in patients with advanced PD. Material and Method: Twenty-seven patients with 2-year follow-up and complete data were enrolled for retrospective evaluation of Unified Parkinson's Disease Rating Scale (UPDRS) and levodopa equivalent dose (LED). Postoperative UPDRS at 6-month, 1-year and 2-years were compared with the preoperative corresponding UPDRS. Postoperative LED at 2 years was compared with the preoperative baseline. Statistical analysis was performed with paired t-test. Additionally, 62 patients with STN-DBS were enrolled for evaluation of treatment complications. Results: Of 27 patients with complete 2-years follow-up, preoperative dopamine challenge test showed 50.6% improvement of motor score (UPDRS axis III). Mentation, behavior and mood (UPDRS axis I) were not significantly improved in each subscore, but significantly improved in the total score. Marked improvement of activities of daily living (UPDRS axis II) and complications of therapy (UPDRS IV) was found. Two-year postoperative motor score (UPDRS axis III) during "off medication-on stimulator" showed progressive and dramatic improvement by mean of 59.83%. The present study also revealed significant improvement of motor score (UPDRS axis III) during "on medication-on stimulator" in some items. A significant 33.4% reduction of LED was noted. Of 62 patients with bilateral STN-DBS, there was 1 asymptomatic intracerebral hemorrhage (0.8% per side), 2 speech difficulty (3.2%), 1 transient confusion (1.6%), 2 transient hypomania (3.2%), 1 stimulation induced hemiballism (1.6%), 1 wound infection (1.6%) and 1 lead malposition (0.8% per side). Conclusion STN-DBS is a safe and effective treatment for PD complicated by motor fluctuation or dyskinesia. The operative outcomes show long-term improvement of activities of daily living, motor function and reduction of medication and drugrelated complications. 2018-09-24T09:28:55Z 2018-09-24T09:28:55Z 2010-05-01 Article Journal of the Medical Association of Thailand. Vol.93, No.5 (2010), 529-540 01252208 01252208 2-s2.0-77952948122 https://repository.li.mahidol.ac.th/handle/123456789/29676 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=77952948122&origin=inward
institution Mahidol University
building Mahidol University Library
continent Asia
country Thailand
Thailand
content_provider Mahidol University Library
collection Mahidol University Institutional Repository
topic Medicine
spellingShingle Medicine
Sarun Nunta-Aree
Bunpot Sitthinamsuwan
Kanokwan Boonyapisit
Apichart Pisarnpong
Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease
description Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the recent surgical treatment of choice for patients with idiopathic Parkinson's disease (PD) complicated by motor fluctuation and disabling dyskinesia. Objective: To study 2 years clinical outcomes, changes of medication and complications following STN-DBS in patients with advanced PD. Material and Method: Twenty-seven patients with 2-year follow-up and complete data were enrolled for retrospective evaluation of Unified Parkinson's Disease Rating Scale (UPDRS) and levodopa equivalent dose (LED). Postoperative UPDRS at 6-month, 1-year and 2-years were compared with the preoperative corresponding UPDRS. Postoperative LED at 2 years was compared with the preoperative baseline. Statistical analysis was performed with paired t-test. Additionally, 62 patients with STN-DBS were enrolled for evaluation of treatment complications. Results: Of 27 patients with complete 2-years follow-up, preoperative dopamine challenge test showed 50.6% improvement of motor score (UPDRS axis III). Mentation, behavior and mood (UPDRS axis I) were not significantly improved in each subscore, but significantly improved in the total score. Marked improvement of activities of daily living (UPDRS axis II) and complications of therapy (UPDRS IV) was found. Two-year postoperative motor score (UPDRS axis III) during "off medication-on stimulator" showed progressive and dramatic improvement by mean of 59.83%. The present study also revealed significant improvement of motor score (UPDRS axis III) during "on medication-on stimulator" in some items. A significant 33.4% reduction of LED was noted. Of 62 patients with bilateral STN-DBS, there was 1 asymptomatic intracerebral hemorrhage (0.8% per side), 2 speech difficulty (3.2%), 1 transient confusion (1.6%), 2 transient hypomania (3.2%), 1 stimulation induced hemiballism (1.6%), 1 wound infection (1.6%) and 1 lead malposition (0.8% per side). Conclusion STN-DBS is a safe and effective treatment for PD complicated by motor fluctuation or dyskinesia. The operative outcomes show long-term improvement of activities of daily living, motor function and reduction of medication and drugrelated complications.
author2 Mahidol University
author_facet Mahidol University
Sarun Nunta-Aree
Bunpot Sitthinamsuwan
Kanokwan Boonyapisit
Apichart Pisarnpong
format Article
author Sarun Nunta-Aree
Bunpot Sitthinamsuwan
Kanokwan Boonyapisit
Apichart Pisarnpong
author_sort Sarun Nunta-Aree
title Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease
title_short Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease
title_full Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease
title_fullStr Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease
title_full_unstemmed Sw2-year outcomes of subthalamic deep brain stimulation for idiopathic Parkinson's disease
title_sort sw2-year outcomes of subthalamic deep brain stimulation for idiopathic parkinson's disease
publishDate 2018
url https://repository.li.mahidol.ac.th/handle/123456789/29676
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