Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

  • Lee, Ji-Yeoun (Department of Neurosurgery, Cancer Research Institute, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Han, Jung-Ho (Department of Neurosurgery, Cancer Research Institute, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Kim, Han-Joon (Department of Neurology, Inje University College of Medicine Ilsan Paik Hospital) ;
  • Jeon, Beom-Seok (Department of Neurology, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Kim, Dong-Gyu (Department of Neurosurgery, Cancer Research Institute, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Paek, Sun-Ha (Department of Neurosurgery, Cancer Research Institute, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital)
  • Published : 2008.07.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : In the evaluation of patients with Parkinson's disease (PD), most neurologists only see their patients during a limited period of their fluctuating 24-hour-a-day lives. This study aimed to assess the short-term outcome of STN stimulation for patients with advanced PD evaluated in a 24-hour monitoring unit for movement disorder (MUMD) using a prospective protocol. Methods : Forty-two patients with advanced PD consecutively treated with bilateral STN stimulation using multi-channel microelectrode recording were included in this study. All patients were evaluated using a 24-hour MUMD with a video recording/editing system and were evaluated with a prospective protocol of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Staging, Schwab and England Activities of Daily Living, levodopa equivalent daily dose (LEDD), Short Form-36 Health Survey, and neuropsychological tests. Magnetic resonance (MR) images of the brain were performed prior to and six months after surgery. Results : All patients were evaluated at three and six months after surgery. There was a rapid and significant improvement of the motor symptoms, especially in tremor and rigidity, after STN stimulation with low morbidity. Dyskinesia was markedly decreased with much lowered LEDD values by 50% after STN stimulation. 1.5T MR images were safely taken according to the manufacturer's guidelines at six months after surgery without any adverse effects in 41 patients treated with STN stimulations. Conclusion : Evaluations in a 24-hour monitoring unit could reduce the dose of medication efficiently to an optimal level with patients' comfort and improve the clinical symptoms in harmony with STN stimulation.

Keywords

References

  1. Bejjani BP, Dormont D, Pidoux B, Yelnik J, Damier P, Arnulf I, et al: Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg 92 : 615-625, 2000 https://doi.org/10.3171/jns.2000.92.4.0615
  2. Benabid AL, Benazzouz A, Hoffmann D, Limousin P, Krack P, Pollak P: Long-term electrical inhibition of deep brain targets in movement disorders. Mov Disord 13 (Suppl 3) : S119-125, 1998 https://doi.org/10.1002/mds.870131321
  3. Benabid AL, Chabardes S, Seigneuret E : Deep-brain stimulation in Parkinson's disease: long-term efficacy and safety - What happened this year? Curr Opin Neurol 18 : 623-630, 2005 https://doi.org/10.1097/01.wco.0000186839.53807.93
  4. Benazzouz A, Breit S, Koudsie A, Pollak P, Krack P, Benabid AL : Intraoperative microrecordings of the subthalamic nucleus in parkinson's disease. Mov Disord 17 (Suppl 3) : S145-149, 2002 https://doi.org/10.1002/mds.1280
  5. Brooks ML, O'Connor MJ, Sperling MR, Mayer DP : Magnetic resonance imaging in localization of EEG depth electrodes for seizure monitoring. Epilepsia 33 : 888-891, 1992 https://doi.org/10.1111/j.1528-1157.1992.tb02196.x
  6. Capecci M, Ricciuti RA, Burini D, Bombace VG, Provinciali L, Iacoangeli M, et al : Functional improvement after subthalamic stimulation in Parkinson's disease : a non-equivalent controlled study with 12-24 month follow up. J Neurol Neurosurg Psychiatry 76 : 769-774, 2005 https://doi.org/10.1136/jnnp.2004.047001
  7. Coenen VA, Gielen F, Rohde I, Fromm C, Kronenbürger M, Dammert S, et al : Subthalamic nucleus stimulation for advanced Parkinson's disease: how to find a far medial STN. Minim Invas Neurosurg 47 : 373-377, 2004 https://doi.org/10.1055/s-2004-830132
  8. Deep-Brain Stimulation for Parkinson's Disease Study Group : Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345 : 956-963, 2001 https://doi.org/10.1056/NEJMoa000827
  9. Dormont D, Cornu P, Pidoux B, Bonnet AM, Biondi A, Oppenheim C, et al : Chronic thalamic stimulation with threedimensional MR stereotactic guidance. AJNR Am J Neuroradiol 18 :1093-1107, 1997
  10. Fraix V, Pollak P, Moro E, Chabardes S, Xie J, Ardouin C, et al : Subthalamic nucleus stimulation in tremor dominant parkinsonian patients with previous thalamic surgery. J Neurol Neurosurg Psychiatry 76 : 246-248, 2005 https://doi.org/10.1136/jnnp.2003.022707
  11. Fraix V, Pollak P, Van Blercom N, Xie J, Krack P, Koudsie A, et al : Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinson's disease. Neurology 55 : 1921-1923, 2000 https://doi.org/10.1212/WNL.55.12.1921
  12. Godinho F, Thobois S, Magnin M, Guenot M, Polo G, Benatru I, et al : Subthalamic nucleus stimulation in Parkinson's disease : Anatomical and electrophysiological localization of active contacts. J Neurol 253 : 1347-1355, 2006 https://doi.org/10.1007/s00415-006-0222-z
  13. Henderson JM, Tkach J, Phillips M, Baker K, Shellock FG, Rezai AR : Permanent neurological deficit related to magnetic resonance imaging in a patient with implanted deep brain stimulation electrodes for Parkinson's disease : case report. Neurosurgery 57 : E1063, 2005 https://doi.org/10.1227/01.NEU.0000180810.16964.3E
  14. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, et al : Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349 : 1925-1934, 2003 https://doi.org/10.1056/NEJMoa035275
  15. Krack P, Fraix V, Mendes A, Benabid AL, Pollak P : Postoperative management of subthalamic nucleus stimulation for Parkinson's disease. Mov Disord 17 : S188-197, 2002 https://doi.org/10.1002/mds.1276
  16. Kumar R, Lozano AM, Kim YJ, Hutchison WD, Sime E, Halket E, et al : Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 51 : 850-855, 1998 https://doi.org/10.1212/WNL.51.3.850
  17. Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffman D, et al : Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339 : 1105-1111, 1998 https://doi.org/10.1056/NEJM199810153391603
  18. Limousin-Dowsey P, Pollak P, Van Blercom N, Krack P, Benazzouz A, Benabid A : Thalamic, subthalamic nucleus and internal pallidum stimulation in Parkinson's disease. J Neurol 246 (Suppl 2) : II42-45, 1999 https://doi.org/10.1007/PL00007750
  19. Minguez-Castellanos A, Escamilla-Sevilla F, Katati MJ, Martin- Linares JM, Meersmans M, Ortega-Moreno A, et al : Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease : target related effect or selection bias? J Neurol Neurosurg Psychiatry 76 : 34-39, 2005 https://doi.org/10.1136/jnnp.2003.032623
  20. Moro E, Scerrati M, Romito LM, Roselli R, Tonali P, Albanese A : Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson's disease. Neurology 53 : 85-90, 1999 https://doi.org/10.1212/WNL.53.1.85
  21. Nussbaum RL, Ellis CE : Alzheimer's disease and Parkinson's disease. N Engl J Med 348 : 1356-1364, 2003 https://doi.org/10.1056/NEJM2003ra020003
  22. Nutt JG, Anderson VC, Peacock JH, Hammerstad JP, Burchiel KJ : DBS and diathermy interaction induces severe CNS damage. Neurology 56 : 1384-1386, 2001 https://doi.org/10.1212/WNL.56.10.1384
  23. Olanow CW, Brin MF, Obeso JA : The role of deep brain stimulation as a surgical treatment for Parkinson's disease. Neurology 55 (12 Suppl 6) : S60-66, 2000
  24. Pollak P, Fraix V, Krack P, Moro E, Mendes A, Chabardes S, et al : Treatment results : Parkinson's disease Mov Disord 17 (Suppl 3) : S75-83, 2002
  25. Rezai AR, Lozano AM, Crawley AP, Joy ML, Davis KD, Kwan CL, et al : Thalamic stimulation and functional magnetic resonance imaging : Localization of cortical and subcortical activation with implanted electrodes : Technical note. J Neurosurg 90 : 583-590, 1999 https://doi.org/10.3171/jns.1999.90.3.0583
  26. Rezai AR, Phillips M, Baker K, Sharan AD, Nyenhuis J, Tkach J, et al : Neurostimulation systems used for deep brain stimulation (DBS) : MR safety issues and implications for failing to follow guidelines. Invest Radiol 39 : 300-303, 2004 https://doi.org/10.1097/01.rli.0000124940.02340.ab
  27. Rodriguez-Oroz MC, Zamarbide I, Guridi J, Palmero MR, Obeso JA : Efficacy of deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease 4 years after surgery : double blind and open label evaluation. J Neurol Neurosurg Psychiatry 75 : 1382-1385, 2004 https://doi.org/10.1136/jnnp.2003.031294
  28. Romito LM, Scerrati M, Contarino MF, Iacoangeli M, Bentivoglio AR, Albanese A : Bilateral high frequency subthalamic stimulation in Parkinson's disease: long-term neurological follow-up. J Neurosurg Sci 47 : 119-128, 2003
  29. Simon SL, Douglas P, Baltuch GH, Jaggi JL : Error analysis of MRI and Leksell stereotactic frame target localization in deep brain stimulation surgery. Stereotact Funct Neurosurg 83 : 1-5, 2005 https://doi.org/10.1159/000083861
  30. Spiegel J, Fuss G, Backens M, Reith W, Magnus T, Becker G, et al : Transient dystonia following magnetic resonance imaging in a patient with deep brain stimulation electrodes for the treatment of Parkinson's disease. J Neurosurg 99 : 772-774, 2003 https://doi.org/10.3171/jns.2003.99.4.0772
  31. Thobois S, Mertens P, Guenot M, Hernier M, Mollion H, Bouvard M, et al : Subthalamic nucleus stimulation in Parkinson's disease : clinical evaluation of 18 patients. J Neurol 249 : 529-534, 2002 https://doi.org/10.1007/s004150200059
  32. Tronnier VM, Staubert A, Hahnel S, Sarem-Aslani A : Magnetic resonance imaging with implanted neurostimulators : an in vitro and in vivo study. Neurosurgery 44 : 118-125 ; discussion 125- 126, 1999 https://doi.org/10.1097/00006123-199901000-00073
  33. Uitti RJ, Tsuboi Y, Pooley RA, Putzke JD, Turk MF, Wszolek ZK, et al : Magnetic resonance imaging and deep brain stimulation. Neurosurgery 51 : 1423-1428 ; discussion 1428-1431, 2002 https://doi.org/10.1097/00006123-200212000-00012
  34. Volkmann J, Allert N, Voges J, Weiss PH, Freund HJ, Stürm V : Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 56 : 548-551, 2001 https://doi.org/10.1212/WNL.56.4.548
  35. Woods SP, Fields JA, Troster AI : Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson's disease : a critical review. Neuropsychol Rev 12 : 111-126, 2002 https://doi.org/10.1023/A:1016806711705
  36. Yamamoto T, Katayama Y, Fukaya C, Kurihara J, Oshima H, Kasai M : Thalamotomy caused by cardioversion in a patient treated with deep brain stimulation. Stereotact Funct Neurosurg 74 : 73-82, 2000 https://doi.org/10.1159/000056466
  37. Zhang J, Wilson CL, Levesque MF, Behnke EJ, Lufkin RB : Temperature changes in nickel-chromium intracranial depth electrodes during MR scanning. AJNR Am J Neuroradiol 14 : 497-500, 1993
  38. Zonenshayn M, Rezai AR, Mogilner AY, Beric A, Sterio D, Kelly PJ : Comparsion of anatomic and neurophysiological methods for subthalamic nucleus targeting. Neurosurgery 47 : 282-292 ; discussion 292-294, 2000 https://doi.org/10.1097/00006123-200008000-00005