Eight-year follow-up outcome of subthalamic deep brain stimulation for Parkinson's disease: Maintenance of therapeutic efficacy with a relatively low levodopa dosage and stimulation intensity

CNS Neurosci Ther. 2021 Nov;27(11):1366-1373. doi: 10.1111/cns.13713. Epub 2021 Aug 5.

Abstract

Aims: This follow-up study aimed to examine the 8-year efficacy and safety of subthalamic nucleus (STN) deep brain stimulation (DBS) for patients with Parkinson's disease (PD) in southern China.

Methods: The follow-up data of 10 patients with PD undergoing STN-DBS were analyzed. Motor symptoms were assessed before and 1, 3, 5, and 8 years after the surgery with stimulation-on in both off-medication (off-med) and on-medication (on-med) status using the Unified Parkinson's disease Rating Scale Part III. The quality of life was assessed using the 39-item Parkinson's Disease Questionnaire. The sleep, cognition, and emotion were evaluated using a series of nonmotor scales. Levodopa equivalent daily dose (LEDD) and stimulation parameters were recorded at each follow-up.

Results: The motor symptoms were improved by 50.9%, 37.7%, 36.7%, and 37.3% in 1, 3, 5, and 8 years, respectively, in the off-med / stimulation-on status compared with the baseline. The quality of life improved by 39.7% and 56.1% in 1 and 3 years, respectively, but declined to the preoperative level thereafter. The sleep, cognition, and emotion were mostly unchanged. LEDD reduced from 708.1 ± 172.5 mg to 330 ± 207.8 mg in 8 years. The stimulation parameters, including amplitude, pulse width, and frequency, were 2.77 ± 0.49 V, 71.3 ± 12.8 μs, and 121.5 ± 21 Hz, respectively, in 8 years.

Conclusion: Long-term therapeutic efficacy of STN-DBS could be achieved even with relatively low stimulation intensity and medication dosage for PD patients in southern China. Motor improvement and medication reduction were maintained through the 8-year follow-up, but improvement in quality of life lasted for only 3 years. No definite changes was found in nonmotor symptoms after STN-DBS.

Keywords: Parkinson's disease; deep brain stimulation; follow-up Studies; subthalamic nucleus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / therapeutic use*
  • China
  • Cognition
  • Deep Brain Stimulation / methods*
  • Deep Brain Stimulation / psychology
  • Emotions
  • Female
  • Follow-Up Studies
  • Humans
  • Levodopa / administration & dosage
  • Levodopa / therapeutic use*
  • Male
  • Mental Status and Dementia Tests
  • Middle Aged
  • Parkinson Disease / psychology
  • Parkinson Disease / therapy*
  • Quality of Life
  • Sleep Quality
  • Subthalamic Nucleus*
  • Surveys and Questionnaires
  • Treatment Outcome

Substances

  • Antiparkinson Agents
  • Levodopa