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Motor symptoms after deep brain stimulation of the subthalamic nucleus
Author(s) -
Lilleeng B.,
Gjerstad M.,
Baardsen R.,
Dalen I.,
Larsen J. P.
Publication year - 2015
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12342
Subject(s) - deep brain stimulation , subthalamic nucleus , parkinsonism , parkinson's disease , motor symptoms , cohort , physical medicine and rehabilitation , movement disorders , dopaminergic , gait , medicine , physical therapy , disease , psychology , dopamine
Objectives Stimulation of the subthalamic nucleus ( STN ‐ DBS ) is an established treatment with long‐term beneficial effects on motor symptoms in patients with P arkinson's disease ( PD ). The efficacy of STN ‐ DBS on non‐dopaminergic motor symptoms remains less elucidated. In this study, we have examined short‐ and long‐term impacts of STN ‐ DBS on the development of the postural instability and gait difficulties ( PIGD ) phenotype, freezing of gait ( FOG ), and falls. Materials and methods We collected data from a prospectively followed cohort of patients that had been operated with STN ‐ DBS 6–9 years before final examination and compared our findings to the longitudinal development of the same symptoms in a non‐operated, historical reference population. Results During short‐term follow‐up after surgery, we observed a marked improvement in mean UPDRS ‐motor score from 27 to 18. We also found clear improvements in tremor, bradykinesia, rigidity, and PIGD scores. However, 6–9 years after surgery, all patients had a dominating PIGD pattern of parkinsonism and 50% of the patients had developed FOG and/or had become recurrent fallers. The disease development in a group of patients with PD from the presurgery period had a similar trajectory as among the operated patients. In addition, mean annual change of both bradykinesia and PIGD scores was nearly identical in both study groups while tremor and rigidity had a significant better development in the operated patients. Conclusions We found that STN ‐ DBS induces an acute improvement of PIGD symptoms. The following long‐term development was however characterized by a marked progression of non‐dopaminergic symptoms.