Long term follow-up in advanced Parkinson’s disease treated with DBS of the subthalamic nucleus

• Published in: Journal of neurology Vol. 268; no. 8; pp. 2821 - 2830
• Main Authors: Volonté, Maria Antonietta, Clarizio, Giacomo, Galantucci, Sebastiano, Scamarcia, Pietro Giuseppe, Cardamone, Rosalinda, Barzaghi, Lina Raffaella, Falautano, Monica, Mortini, Pietro, Comi, Giancarlo, Filippi, Massimo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2021; Springer Nature B.V
• Subjects: Cognitive ability; Deep brain stimulation; Dopamine receptors; Dosage; Electrical stimuli; Medicine; Medicine & Public Health; Motor systems; Movement disorders; Neurodegenerative diseases; Neurology; Neuroradiology; Neurosciences; Original Communication; Parkinson's disease; Patients; Quality of life; Solitary tract nucleus; Subthalamic nucleus; Surgery; Tremor; Subthalamic nucleus; Deep brain stimulation; Parkinson’s disease; Follow-up studies
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-021-10430-y

Background Parkinson’s disease (PD) is the second most common neurodegenerative disorder, affecting both motor and non-motor systems. Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been an approved treatment for PD for more than 30 years, but few data are available regarding its long-term effectiveness. Objective The aim of this study is to evaluate patients’ outcome, both from a motor and non-motor perspective, 9 to 14 years after DBS implantation. We have investigated patients with advanced PD and treated with STN-DBS, in relation to key clinical features of PD. Methods 18 patients were assessed both retrospectively and prospectively. They underwent motor examination, neuropsychological evaluation and questionnaires on the quality of life, preoperatively, as well as 1, 9 and 14 years after DBS surgery. All patients were implanted with STN-DBS at San Raffaele Hospital between 2004 and 2010. Results 13 males and five females underwent DBS implantation with a mean PD duration of 11 years. Stimulation significantly improved med-off/stim-on condition up to 9 years, compared to the preoperative off state, and med-on/stim-on condition at 14 years, compared to med-on/stim-off state. Long term improvement specifically involved tremor and rigidity, as well as dopaminergic daily dose. At the same time, STN-DBS had no long-lasting effect on axial symptoms and cognitive functions. Conclusions STN-DBS remains an effective therapy for advanced PD, also over the years. Despite the underlying progression of the disease, this treatment extends the period in which the overall quality of life is still acceptable.