Subthalamic nucleus Deep brain stimulation (STN-DBS) continues to be effective for the following patients: Parkinson’s disease More than 15 years after implantation of the (PD) device, new studies show a significant improvement in motor complications and a stable reduction in dopaminergic drug use.
“Subthalamic nucleus stimulation is a well-known treatment used to improve motor status and quality of life in PD patients. For the first time, our study is very long-term, that is, 15 after surgery. The diagnosis has been supporting its effectiveness for 25 years from the year and PD, “said Elena Moro, MD, MD, of the University of the Grenoble Alps in Grenoble, France. Medscape Medical News..
“This information is important when doctors, patients, and their families need to make decisions about surgical options for dealing with PD,” Moro said.
Research Published online June 2 neurology..
“Don’t delay”
The findings are based on 51 PD patients treated with STN-DBS on both sides for an average of 17 years (range, 15-24 years). The average age at diagnosis was 40 years and the average age at device implantation was 51 years.
The results show that STN-DBS has been effective against motor complications for over 15 years, reducing dyskinesia time by 75% and off state by 58.7%. This is similar to the amount of improvement seen one year after surgery.
Dopaminergic drug doses remained low at long-term follow-up. The dose was reduced by 50.6% compared to baseline.
There was also a continuous improvement in quality of life. The quality of life questionnaire for Parkinson’s disease scored 13.8% better than baseline in the very long term.
“During follow-up, few device-related adverse events were observed and were manageable in most cases,” the author reports in the article.
“If the patient’s condition is not optimized by treatment, deep brain stimulation is already recommended. PD patients without dementia and in good general health are the best candidates for this surgery.” Said Dr. Moro.
“Given our results and the data available in the literature, DBS surgery should not be delayed if patients meet the selection criteria and their motor status and quality of life deteriorate despite treatment.” She added.
Innovative treatment
The authors of the linked editorial state that these results show better exercise results with less medication and “reinforce why STN-DBS has revolutionized the treatment of progressive PD.” ..
Dr. Kelvin Chow, MD, University of Michigan, Ann Arbor, Michigan, and Dr. David Charles, MD, Vanderbilt University, Nashville, Tennessee, point out that longer periods of illness increase the likelihood of cognitive impairment and mental illness. I will. It is a risk factor for placement in elderly homes and limits the ability to use dopamine agonists.
Many of the patients in this cohort experienced hallucinations and psychosis during long follow-up periods, but “I can imagine that without DBS therapy, the number and severity of patients would increase,” they wrote. I will.
According to Chou and Charles, an important caveat is that the results are based on a carefully selected cohort and the patients are managed by experts in the areas of movement disorders and DBS.
In addition, the patient’s condition was very sensitive to levodopa. The exercise score on the Integrated Parkinson’s Disease Rating Scale improved by 75.3% at baseline from off to on. In general, most DBS centers consider about 30% of levodopa reactions to be an acceptable cutoff for advancing STN-DBS, they point out.
Despite these caveats and limitations, the findings are important for counseling potential DBS candidates, says Chou and Charles.
“A common question that patients have is,’How long will the benefits of DBS last?’. At least for STN-DBS, improvement in motor complications lasts for more than 15 years, often accompanied by improved quality of life. Can reassure them. For a long time, “the editorial writer concludes.
There was no targeted funding for this study. Moro was honored by Medtronic and Abbott for consulting and speaking, and received educational grants from Boston and Neuronica. A complete list of disclosures for authors and editor writers is available in the original article.
neurologyPublished online on June 2, 2021. Overview, Editorial
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