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Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients.
J Neurosurg. 2001 Aug; 95(2):213-21.JN

Abstract

OBJECT

A blinded evaluation of the effects of subthalamic nucleus (STN) stimulation was performed in levodopa-intolerant patients with Parkinson disease (PD). These patients (Group I, seven patients) were moderately or severely disabled (Hoehn and Yahr Stages III-V during the off period), but were receiving only a small dose of medication (levodopa-equivalent dose [LED] 0-400 mg/day) because they suffered unbearable side effects. The results were analyzed in comparison with those obtained in patients with advanced PD (Group II, seven patients) who were severely disabled (Hoehn and Yahr Stages IV and V during the off period), but were treated with a large dose of medication (500-990 mg/day).

METHODS

The patients were evaluated twice at 6 to 8 months after surgery. To determine the actual benefits afforded by STN stimulation to their overall daily activities, the patients were maintained on their medication regimen with optimal doses and schedules. Stimulation was turned off overnight for at least 12 hours. It was turned on in the morning (or remained turned off), and each patient's best and worst scores on the Unified Parkinson's Disease Rating Scale during waking daytime activity were recorded as on- and off-period scores, respectively. The order of assessment with respect to whether stimulation was occurring was determined randomly. The STN stimulation markedly improved daily activity and total motor scores in Group I patients. The percentage time of immobility (Hoehn and Yahr Stages IV and V) became 0% in patients who were intermittently immobile while not receiving stimulation. Improvements were demonstrated in tremor, rigidity. akinesia, and gait subscores. The STN stimulation produced less marked but still noticeable improvements in the daily activity and total motor scores in Group II patients. The percentage time of immobility as well as the LED was reduced in patients who displayed intermittent immobility with pronounced motor fluctuations while not receiving stimulation. Improvements were demonstrated in tremor, rigidity, and dyskinesia subscores in these patients. In contrast, STN stimulation did not improve the overall daily activities at all in patients who had become unresponsive to a tolerable dose of levodopa and were continuously immobile, even though these patients' tremor and rigidity subscores were still improved by stimulation.

CONCLUSIONS

Consistent with earlier findings, the great benefit of STN stimulation in levodopa-intolerant patients is that STN stimulation can reduce the level of required levodopa medication. This suggests that STN stimulation could be a therapeutic option for patients with less-advanced PD by allowing levodopa medication to be maintained at as low a dose as possible, and to prevent adverse reactions to the continued use of large-dose levodopa.

Authors+Show Affiliations

Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. ykatayam@med.nihon-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11780890

Citation

Katayama, Y, et al. "Subthalamic Nucleus Stimulation for Parkinson Disease: Benefits Observed in Levodopa-intolerant Patients." Journal of Neurosurgery, vol. 95, no. 2, 2001, pp. 213-21.
Katayama Y, Kasai M, Oshima H, et al. Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients. J Neurosurg. 2001;95(2):213-21.
Katayama, Y., Kasai, M., Oshima, H., Fukaya, C., Yamamoto, T., Ogawa, K., & Mizutani, T. (2001). Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients. Journal of Neurosurgery, 95(2), 213-21.
Katayama Y, et al. Subthalamic Nucleus Stimulation for Parkinson Disease: Benefits Observed in Levodopa-intolerant Patients. J Neurosurg. 2001;95(2):213-21. PubMed PMID: 11780890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients. AU - Katayama,Y, AU - Kasai,M, AU - Oshima,H, AU - Fukaya,C, AU - Yamamoto,T, AU - Ogawa,K, AU - Mizutani,T, PY - 2002/1/10/pubmed PY - 2002/1/26/medline PY - 2002/1/10/entrez SP - 213 EP - 21 JF - Journal of neurosurgery JO - J Neurosurg VL - 95 IS - 2 N2 - OBJECT: A blinded evaluation of the effects of subthalamic nucleus (STN) stimulation was performed in levodopa-intolerant patients with Parkinson disease (PD). These patients (Group I, seven patients) were moderately or severely disabled (Hoehn and Yahr Stages III-V during the off period), but were receiving only a small dose of medication (levodopa-equivalent dose [LED] 0-400 mg/day) because they suffered unbearable side effects. The results were analyzed in comparison with those obtained in patients with advanced PD (Group II, seven patients) who were severely disabled (Hoehn and Yahr Stages IV and V during the off period), but were treated with a large dose of medication (500-990 mg/day). METHODS: The patients were evaluated twice at 6 to 8 months after surgery. To determine the actual benefits afforded by STN stimulation to their overall daily activities, the patients were maintained on their medication regimen with optimal doses and schedules. Stimulation was turned off overnight for at least 12 hours. It was turned on in the morning (or remained turned off), and each patient's best and worst scores on the Unified Parkinson's Disease Rating Scale during waking daytime activity were recorded as on- and off-period scores, respectively. The order of assessment with respect to whether stimulation was occurring was determined randomly. The STN stimulation markedly improved daily activity and total motor scores in Group I patients. The percentage time of immobility (Hoehn and Yahr Stages IV and V) became 0% in patients who were intermittently immobile while not receiving stimulation. Improvements were demonstrated in tremor, rigidity. akinesia, and gait subscores. The STN stimulation produced less marked but still noticeable improvements in the daily activity and total motor scores in Group II patients. The percentage time of immobility as well as the LED was reduced in patients who displayed intermittent immobility with pronounced motor fluctuations while not receiving stimulation. Improvements were demonstrated in tremor, rigidity, and dyskinesia subscores in these patients. In contrast, STN stimulation did not improve the overall daily activities at all in patients who had become unresponsive to a tolerable dose of levodopa and were continuously immobile, even though these patients' tremor and rigidity subscores were still improved by stimulation. CONCLUSIONS: Consistent with earlier findings, the great benefit of STN stimulation in levodopa-intolerant patients is that STN stimulation can reduce the level of required levodopa medication. This suggests that STN stimulation could be a therapeutic option for patients with less-advanced PD by allowing levodopa medication to be maintained at as low a dose as possible, and to prevent adverse reactions to the continued use of large-dose levodopa. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/11780890/Subthalamic_nucleus_stimulation_for_Parkinson_disease:_benefits_observed_in_levodopa_intolerant_patients_ L2 - https://thejns.org/doi/10.3171/jns.2001.95.2.0213 DB - PRIME DP - Unbound Medicine ER -