Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease

Francesco Bove; Delia Mulas; Francesco Cavallieri; Anna Castrioto; Stephan Chabardès; Sara Meoni; Emmanuelle Schmitt; Amélie Bichon; Enrico Di Stasio; Andrea Kistner; Pierre Pélissier; Eric Chevrier; Eric Seigneuret; Paul Krack; Valerie Fraix; Elena Moro

doi:10.1212/WNL.0000000000012246

Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease

Neurology. 2021 Jul 19;97(3):e254-e262. doi: 10.1212/WNL.0000000000012246.

Authors

Francesco Bove¹, Delia Mulas¹, Francesco Cavallieri¹, Anna Castrioto¹, Stephan Chabardès¹, Sara Meoni¹, Emmanuelle Schmitt¹, Amélie Bichon¹, Enrico Di Stasio¹, Andrea Kistner¹, Pierre Pélissier¹, Eric Chevrier¹, Eric Seigneuret¹, Paul Krack¹, Valerie Fraix¹, Elena Moro²

Affiliations

¹ From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland.
² From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland. elenamfmoro@gmail.com.

PMID: 34078713
DOI: 10.1212/WNL.0000000000012246

Abstract

Objective: To evaluate the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) on motor complications in patients with Parkinson disease (PD) beyond 15 years after surgery.

Methods: Data on motor complications, quality of life (QoL), activities of daily living, Unified Parkinson's Disease Rating Scale motor scores, dopaminergic treatment, stimulation measures, and side effects of STN-DBS were retrospectively retrieved and compared before surgery, at 1 year, and beyond 15 years after bilateral STN-DBS.

Results: Fifty-one patients with 17.06 ± 2.18 years STN-DBS follow-up were recruited. Compared to baseline, the time spent with dyskinesia and the time spent in the "off" state were reduced by 75% (p < 0.001) and by 58.7% (p < 0.001), respectively. Moreover, dopaminergic drugs were reduced by 50.6% (p < 0.001). Parkinson's Disease Quality of Life Questionnaire total score and the emotional function and social function domains improved 13.8% (p = 0.005), 13.6% (p = 0.01), and 29.9% (p < 0.001), respectively. Few and mostly manageable device-related adverse events were observed during the follow-up.

Conclusions: STN-DBS is effective beyond 15 years from the intervention, notably with significant improvement in motor complications and stable reduction of dopaminergic drugs. Furthermore, despite the natural continuous progression of PD with worsening of levodopa-resistant motor and nonmotor symptoms over the years, patients undergoing STN-DBS could maintain an improvement in QoL.

Classification of evidence: This study provides Class IV evidence that, for patients with PD, STN-DBS remains effective at treating motor complications 15 years after surgery.

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