Electrical stimulation of the subthalamic nucleus in advanced Parkinsonian’s disease
N Engl J Med. 1998-10-15; 339(16): 1105-1111
DOI: 10.1056/NEJM199810153391603
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1. N Engl J Med. 1998 Oct 15;339(16):1105-11. doi: 10.1056/NEJM199810153391603.
Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s
disease.
Limousin P(1), Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid
AL.
Author information:
(1)Department of Clinical and Biologic Neurosciences, Joseph Fourier University,
Grenoble, France.
BACKGROUND: In many patients with idiopathic Parkinson’s disease, treatment with
levodopa is complicated by fluctuations between an “off” period, when the
medication is not working and the motor symptoms of parkinsonism are present,
and an “on” period, when the medication is causing improved mobility, often
accompanied by debilitating dyskinesias. In animal models of Parkinson’s
disease, there is overactivity in the subthalamic nucleus, and electrical
stimulation of the subthalamic nucleus improves parkinsonism. We therefore
sought to determine the efficacy and safety of electrical stimulation of the
subthalamic nucleus in patients with Parkinson’s disease.
METHODS: We studied 24 patients with idiopathic Parkinson’s disease in whom
electrodes were implanted bilaterally in the subthalamic nucleus under
stereotactic guidance with imaging and electrophysiologic testing of the
location. Twenty were followed for at least 12 months. Clinical evaluations
included the Unified Parkinson’s Disease Rating Scale, a dyskinesia scale, and
timed tests conducted before and after surgery, when patients were off and on
medications.
RESULTS: After one year of electrical stimulation of the subthalamic nucleus,
the patients’ scores for activities of daily living and motor examination scores
(Unified Parkinson’s Disease Rating Scale parts II and III, respectively) off
medication improved by 60 percent (P