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Effect of unilateral subthalamic deep brain stimulation in highly asymmetrical Parkinson's disease: 7-year follow-up

Title
Effect of unilateral subthalamic deep brain stimulation in highly asymmetrical Parkinson's disease: 7-year follow-up
Authors
Ehm, GwanheeKim, Han-JoonKim, Ji-YoungLee, Jee-YoungKim, Hee JinYun, Ji YoungKim, Young EunYang, Hui-JunLim, Yong HoonJeon, BeomseokPaek, Sun Ha
Ewha Authors
윤지영
Issue Date
2019
Journal Title
JOURNAL OF NEUROSURGERY
ISSN
0022-3085JCR Link

1933-0693JCR Link
Citation
JOURNAL OF NEUROSURGERY vol. 131, no. 5, pp. 1508 - 1513
Keywords
Parkinson's diseaseunilateral deep brain stimulationasymmetryfunctional neurosurgery
Publisher
AMER ASSOC NEUROLOGICAL SURGEONS
Indexed
SCIE; SCOPUS WOS
Document Type
Article
Abstract
OBJECTIVE For patients with highly asymmetrical Parkinson's disease (PD), unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) has been suggested as a reasonable treatment. However, the results of a previous 2-year follow-up study involving patients with prominently asymmetrical PD who had unilateral STN DBS suggested that simultaneous bilateral surgery should be performed. In the present study, the authors analyze 7-year follow-up data from the same patient group to examine changes in motor benefit from unilateral STN DBS over time and the interval between initial unilateral surgery and a second (contralateral) STN DBS surgery. METHODS Eight patients with highly asymmetrical parkinsonism who underwent unilateral STN DBS were evaluated. The factors measured were scores on the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III), Hoehn and Yahr (HY) stage, and levodopa equivalent daily dose (LEDD). Evaluations occurred at 3, 6, and 12 months after the initial surgery and annually thereafter. RESULTS The mean follow-up period was 91.5 months (range 36-105 months). Three years after the initial unilateral surgery, motor benefits on the contralateral side continued; however, an aggravation of the ipsilateral parkinsonism attenuated the improvement in total UPDRS III scores, which reverted to baseline. Axial motor score, LEDD, and HY stage did not differ from the baseline. Seven of 8 patients (87.5%) were considered candidates for a second surgery to offer additional motor benefits. Of the 7 candidates, 4 patients (50% of total patients) underwent the second surgery at 58.5 +/- 11.6 (mean +/- SD) months after the initial surgery. Three patients were not able to have the second surgery: one patient died of gastric cancer, one patient was severely immobilized by an accident, and one patient could not afford the second surgery. One patient remained content with the initial unilateral surgery throughout the follow-up period. CONCLUSIONS Seven of 8 patients with unilateral STN DBS became candidates for second surgery before battery replacement surgery of the first implanted device. Baseline asymmetry alone may not predict appropriate candidates for unilateral STN DBS. This study provides further evidence that, from a long-term perspective, initial simultaneous bilateral STN DBS should be considered for PD patients with prominently asymmetrical motor symptoms.
DOI
10.3171/2018.5.JNS172006
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의과대학 > 의학과 > Journal papers
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