Medical treatment

Subthalamic deep brain stimulation versus best medical treatment: a 12-year follow-up

This article was originally published here

Acta Neurol Belgium. 2022 Jan 27. doi: 10.1007/s13760-022-01874-8. Online ahead of print.

ABSTRACT

OBJECTIVE: Electrical stimulation of the subthalamic nucleus (STN-DBS) is well established for attenuating motor fluctuations in advanced Parkinson’s disease, but little is known about its very long-term efficacy.

Methods: We followed 15 PD patients who underwent STN-DBS for 12 years and compared them to a matched group of 14 patients with the best drug treatment. All had been considered good candidates for surgery. They were assigned to each group based on their own decision.

RESULTS: After 12 years, mortality rates were similar in both groups. In the DBS group, the best “on” UPDRS III scores (under medication, under stimulation) remained significantly better and the dyskinesias shorter and weaker than in the medicated group (under medication only). Yet, looking at independent life and quality of life (QoL) assessed with PDQ39, no significant difference could be observed between the groups at the end of follow-up, likely due to the development of motor and non-motor symptoms resistant to dopa and stimulation. such as falls, freezing, dementia, listlessness, and depression, the latter two being more common in the DBS group.

CONCLUSION: Drug-resistant and DBS-resistant symptoms and signs occur more often after a long disease course and in elderly patients. This is perhaps why the differences in quality of life between the two groups no longer existed after twelve years because, compared to other studies, our patients were older on inclusion.

PMID:35084704 | DOI: 10.1007/s13760-022-01874-8