PT  - JOURNAL ARTICLE
AU  - Kumar, R.
AU  - Lozano, A. M.
AU  - Kim, Y. J.
AU  - Hutchison, W. D.
AU  - Sime, E.
AU  - Halket, E.
AU  - Lang, A. E.
TI  - Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease
AID  - 10.1212/WNL.51.3.850
DP  - 1998 Sep 01
TA  - Neurology
PG  - 850--855
VI  - 51
IP  - 3
4099  - http://n.neurology.org/content/51/3/850.short
4100  - http://n.neurology.org/content/51/3/850.full
SO  - Neurology1998 Sep 01; 51
AB  - Objective: To examine objectively the clinical effects of subthalamic nucleus (STN) deep brain stimulation (DBS) in advanced PD. Methods: Our initial seven consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic STN DBS underwent a standardized preoperative evaluation followed by a 2-day double-blind evaluation of efficacy 6 to 12 months after electrode implantation. Diaries documenting motor fluctuations and dyskinesias were also completed preoperatively and postoperatively. Results: In the medication-off state, turning the stimulators on resulted in improvement in mean total Unified Parkinson's Disease Rating Scale (UPDRS) motor score by 58% including the following improvements in composite scores: akinesia 57%, rigidity 52%, tremor 82%, and gait and postural stability 49%. Additionally, the medication-off state improved 17% without stimulation, possibly as a result of electrode insertion alone or carry-over of chronic stimulation. In the medication-on, stimulation-on state, all major features of parkinsonism improved and total UPDRS motor score improved 41% compared with before surgery. Activities of daily living were improved while off medication 30%, and levodopa-induced dyskinesias were reduced 83% while total drug dosage was decreased 40%. With chronic stimulation, patients reported that the percentage of time spent in the "on" state (without dyskinesias) increased from 26% to 52% and "off" time decreased from 30% to 6%. Operative complications including cognitive worsening were not uncommon. Conclusions: STN DBS is a promising new surgical option for the treatment of advanced PD. The marked clinical benefits obtained in these severely disabled patients outweighed the adverse effects.