Bilateral subthalamic stimulation for advanced
Parkinson disease:
early experience at an Eastern center
Shang-Ming Chiou • Yu-Chin Lin • Ming-Kuei Lu •
Chon-Haw Tsai
Received: 29 September 2014 / Accepted: 8 November 2014 / Published online: 14 November 2014
_ Springer-Verlag Italia 2014
Abstract Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can improve the life quality of
patients with advanced Parkinson disease (PD). However, previous studies have stemmed mainly from Western centers. Present study analyzed the 6-month outcomes of bilateral STN-DBS therapy that were observed during a 9-year period at a Taiwanese institute. We retrospectively reviewed 72 consecutive patients, whose mean disease history was 8 years when they underwent surgery. The median ‘‘drug-off’’ Hoehn and Yahr stage was 3. The STN was targeted using T2-weighted magnetic resonance imaging and electrophysiological guidance. The over-time mean differences in the Unified PD Rating Scale (UPDRS) scores and daily levodopa-equivalent dose (LED) were assessed using the repeated measurements ANOVA at 3 and 6 months relative to those of presurgical drug-off baseline. At 6 months postsurgery, the mean UPDRS total, Part II and Part III subscores significantly decreased by 27, 30 and 25 %, respectively, with clinically high effect size. Tremors were markedly (66 %) ameliorated. Moreover,
problems of akinesia, rigidity, and locomotion were significantly improved by 20 %. The mean daily LED needs
decreased by 25 %; thus, drug-induced dyskinesia was markedly (80 %) diminished. STN-DBS therapy could provide similarly effective impacts to Eastern and Western PD patients. Preoperative optimal selection of patients and postoperative delicate programming ensure a better surgical
improvement.
Keywords Deep brain stimulation _ Effect size _ Microelectrode recordings _ Parkinson disease _ Subthalamic nucleus
Introduction
Idiopathic Parkinson disease (PD) is a complex, progressive neurodegenerative disorder manifested by many motor and non-motor features [1]. The current treatment of choice is mainly medical [2]; however, chronic dopaminergic therapy
is limited by disease progression and development of drugsrelated motor fluctuations or dyskinesia. Surgical interventions
are strongly recommended for these patients [2–5]. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is preferred because most of its adverse effects are reversible, and it causes fewer complications than classic lesion surgery does [6, 7]. STN-DBS exhibited also more effective control of parkinsonian symptoms and reduction of dopaminergics than pallidal DBS does [3, 4, 8].
Previous studies [5, 6, 9–12] reported that 6-month clinical improvements after STN-DBS varied widely (20–75 %) compared to preoperative drug-off baseline. Most studies recruited only low numbers of patients, and stemmed mainly from Western centers [9, 12]. Search of the PubMed database up to July 2014, using the combined MeSH terms of ‘‘deep brain stimulation’’ and ‘‘Parkinson’’ yielded one Japanese (14 patients) [13], one Korean (9 patients) [14], and another Taiwanese (7 patients) [15] reports related to the 6-month efficacy of STN-DBS therapy. The prevalence and incidence rates of PD in Taiwan
