Deep Brain Stimulation Of The Subthalamic Nucleus

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Multiple reports have demonstrated the short-term benefits of STN DBS in controlling the cardinal features of PD and reducing dyskinesia and antiparkinsonian medications (16,24-31). One of the largest studies was conducted by the Deep Brain Stimulation for Parkinson's Disease Study Group (16). This was a multicenter study in which 96 PD patients received bilateral STN DBS and 91 completed the six-month follow-up visit. In the medication off/stimulation on condition at six months compared to the baseline medication off condition there was a mean improvement of 44% in the UPDRS ADL scores and a 51% improvement in UPDRS motor scores. More specifically, tremor was improved by 79%, rigidity by 58%, bradykinesia by 42%, gait by 56%, and postural instability by 50%, all of which were significant improvements compared to baseline. According to patient diaries, there was a significant decrease in daily off time from 49% to 19%, a significant increase in on time without dyskinesia from 27% to 74% and a decrease in on time with dysk-inesia from 23% to 7%. The Rush Dyskinesia Scale demonstrated a significant improvement in dyskinesia of 58% and antiparkinsonian medications were reduced an average of 37%.

Several studies have demonstrated the long-term benefits of STN DBS (23,32-37) (Table 2). Rodriguez-Oroz et al. (23) examined 49 PD patients who received bilateral STN DBS as part of the original Deep Brain Stimulation for Parkinson's Disease Study Group trial (16), three to four years after initial implant. They demonstrated a 43% improvement in UPDRS ADL scores and a 50% improvement in UPDRS motor scores in the medication off/stimulation on condition compared to the baseline medication off state. More specifically, there was an 87% improvement in tremor, a 59% improvement in rigidity, a 42% improvement in bradykinesia, a 41% improvement in gait, a 31% improvement in postural instability, a 59% reduction in dyskinesia, and a 34% reduction in levodopa compared to baseline. Compared with

TABLE 2 Selected Studies of Bilateral Deep Brain Stimulation of the Subthalamic Nucleus

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