Effect of bilateral subthalamic electrical stimulation in Parkinson's disease

Giovanni Broggi, Angelo Franzini, Paolo Ferroli, Domenico Servello, Ludovico D'Incerti, Silvia Genitrini, Paola Soliveri, Floriano Girotti, Tommaso Caraceni

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Bilateral high frequency subthalamic stimulation has been reported to be effective in the treatment of Parkinson's disease and levodopa-induced dyskinesias. To analyze the results of this surgical procedure we critically reviewed 17 parkinsonian patients with advanced disease complicated by motor fluctuations and dyskinesias. METHODS: Between January 1998 and June 1999 these 17 consecutive patients (age 48-68 years; illness duration 8-27 years) underwent bilateral stereotactically guided implantation of electrodes into the subthalamic nucleus in the Department of Neurosurgery of the Istituto Nazionale Neurologico "C. Besta." Parameters used for continuous high-frequency stimulation were: frequency 160 Hz, pulse width 90 μsec, mean amplitude 2.05±0.45 V. Parts II and III of the UPDRS were used to assess motor performance before and after operation by the neurologic team. The follow-up ranged between 6 and 18 months. RESULTS: At latest examination, mean UPDRS II and III scores had improved by 30% (on stimulation, off therapy) with mean 50% reduction in daily off time. Peak dyskinesias and early morning dystonias also improved in relation to therapy reduction. Side effects were persistent postoperative supranuclear oculomotor palsy and postural instability in one case, worsened off-medication hypophonia in three, and temporary nocturnal confusion episodes in three. Postoperative MRI revealed a clinically silent intracerebral haematoma in one case. One electrode required repositioning. CONCLUSIONS: Continuous high frequency STN stimulation is an effective treatment for advanced PD. A functionally useful and safe electrode placement can be performed without microrecording.

Original languageEnglish
Pages (from-to)89-94
Number of pages6
JournalSurgical Neurology
Volume56
Issue number2
DOIs
Publication statusPublished - 2001

Fingerprint

Electric Stimulation
Parkinson Disease
Dyskinesias
Electrodes
Subthalamic Nucleus
Dystonia
Neurosurgery
Levodopa
Therapeutics
Paralysis
Hematoma
Nervous System

Keywords

  • Brain stimulation
  • Parkinson's disease
  • Stereotactic surgery
  • Subthalamic nucleus

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Effect of bilateral subthalamic electrical stimulation in Parkinson's disease. / Broggi, Giovanni; Franzini, Angelo; Ferroli, Paolo; Servello, Domenico; D'Incerti, Ludovico; Genitrini, Silvia; Soliveri, Paola; Girotti, Floriano; Caraceni, Tommaso.

In: Surgical Neurology, Vol. 56, No. 2, 2001, p. 89-94.

Research output: Contribution to journalArticle

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AU - Franzini, Angelo

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AU - Servello, Domenico

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AU - Genitrini, Silvia

AU - Soliveri, Paola

AU - Girotti, Floriano

AU - Caraceni, Tommaso

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AB - BACKGROUND: Bilateral high frequency subthalamic stimulation has been reported to be effective in the treatment of Parkinson's disease and levodopa-induced dyskinesias. To analyze the results of this surgical procedure we critically reviewed 17 parkinsonian patients with advanced disease complicated by motor fluctuations and dyskinesias. METHODS: Between January 1998 and June 1999 these 17 consecutive patients (age 48-68 years; illness duration 8-27 years) underwent bilateral stereotactically guided implantation of electrodes into the subthalamic nucleus in the Department of Neurosurgery of the Istituto Nazionale Neurologico "C. Besta." Parameters used for continuous high-frequency stimulation were: frequency 160 Hz, pulse width 90 μsec, mean amplitude 2.05±0.45 V. Parts II and III of the UPDRS were used to assess motor performance before and after operation by the neurologic team. The follow-up ranged between 6 and 18 months. RESULTS: At latest examination, mean UPDRS II and III scores had improved by 30% (on stimulation, off therapy) with mean 50% reduction in daily off time. Peak dyskinesias and early morning dystonias also improved in relation to therapy reduction. Side effects were persistent postoperative supranuclear oculomotor palsy and postural instability in one case, worsened off-medication hypophonia in three, and temporary nocturnal confusion episodes in three. Postoperative MRI revealed a clinically silent intracerebral haematoma in one case. One electrode required repositioning. CONCLUSIONS: Continuous high frequency STN stimulation is an effective treatment for advanced PD. A functionally useful and safe electrode placement can be performed without microrecording.

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