LONG TERM EFFECTS OF BILATERAL SUBTHALAMIC STIMULATION IN PARKINSON DISEASE

BRUNO VERÓNICA; BRUNO VERÓNICA; PÉREZ LLORET SANTIAGO; , MERELLO MARCELO

Chicago

Congreso; Congreso Internacional de Movimientos Anormales; 2008

Introduction: Chronic subthalamic stimulation is being increasingly used for treatment of Parkinson disease (IPD) patients refractory to medical treatment. In our experience, subthalamic nucleus deep stimulation (DBS-STN) has exhibited remarkable short-term results. On the other hand, the long term effects of this procedure are still not well known. Objective: To evaluate persistence of short-term DBS-STN benefits after three years of treatment. Methods: 38 patients with Parkinson Disease with severe fluctuations that were subjected to chronic subthalamic stimulation under electrophysiological control were evaluated 12 and 36 months after surgery. CAPSIT-PD suggested battery for presurgical and post surgical evaluation was used. Results: Intrasurgical mortality was 0.95% (1 case of intracerebral hemorrhage). Most of complications were reversible and included fever, depression, pneumonia, hypertension, psychosis and insomnia post surgery and belated ocular deviation, seizures and stimulator externalization. They affected 24% of the studied sample. Initial improvements in all evaluated motor variables remained unchanged after the three years follow-up period (p<0.78). Total Motor UPDRS and sub items rigidity, hand bradikinesia, tremor and postural and gait-instability disorder showed a very significant drop that was evident one year after treatment and continued three years later. Dyskinesia score and levodopa dose also showed significant decreases. A non-significant detriment of cognitive functions was noticed one year after surgery, especially in memory, attention, visuoespacial abilities and verbal fluency. This changes became significant after three years of monitoring (p<0.05). Conclusion: Significant clinical motor improvement in Parkinson disease post- subthalamic stimulation persists three years after treatment. Future randomized studies will clarify if the cognitive impairment detected some years after surgery belongs to a stimulation effect or to the disease evolution.