Deep brain stimulation of the subthalamic nucleus in advanced Parkinson’s disease: life quality beyond 15 years of follow-up

Gamaleya, A.; Omarova, S.; Tomskiy, A.; Bril, E.; Shabalov, V.

Авторы: Gamaleya A., Omarova S., Tomskiy A., Bril E., Shabalov V.
Журнал: European Journal of Neurology
Том: 27
Номер: Suppl. 1
Год издания: 2020
Издательство: Blackwell Publishing Inc.
Местоположение издательства: United Kingdom
Первая страница: 878
Последняя страница: 878
DOI: 10.1111/ene.14305
Аннотация: EUROPEAN JOURNAL OF NEUROLOGY Volume 27, Supplement 1, May 2020 Abstracts of the 6th Congress of theEuropean Academy of Neurology Virtual Congress Background and aims: STN-DBS appeared to improve dramatically motor and nonmotor dopamine-sensitive symptoms in advanced PD-patients. However, a disease-modifying effect of STN-DBS was not proved and most of the patients deteriorate over time. We describe the longest follow-up after STN-DBS for PD-patients in our center.Methods: In the first patient, PD manifested at the age of 32years. He developed disabling dyskinesias soon after beginning of levodopa-treatment. Considering accompanying fluctuations, he underwent STN-DBS at 39years (UPDRS-3 OFF/ON:46/19, LEDD:1200mg). The other man had a 9-year PD-history. By the age of 57years, he suffered severe dyskinesias and motor fluctuations, hence he was assigned to STN-DBS (UPDRS-3 OFF/ON:42/13, LEDD:625mg). We assessed patients annually with maximal follow-up of 15years.Results: Following STN-DBS, we observed a significant amelioration of PD-symptoms in OFF-state and decrease in levodopa-induced complications in both patients. In the first patient, correction of right-electrode position was nedeed. By 8th-year of STN-DBS, patient retained moderate improvement in functioning and mobility in OFF-state, however, condition of ON-state deteriorated. By 15th-year, QoL deteriorated compared to preoperative (PDQ-39:112→139), though LEDD remained decreased by 33% and cognitive function preserved (MoCA:29). In the other patient, quality of ON-state got worsen after 10-year follow-up accompanied by progression in cognitive decline. By 15th-year, beside sufficient overall mobility, patient suffered pronounced dementia (MoCA:5) and became depend in most daily activities requiring admission to nursing home. LEDD remained reduced by a half.Conclusion: Our observation demonstrates long-term effect of STN-DBS. Overall long-term outcome varies individually. Nevertheless, PD-progression with augmentation of dopamine-nonresponsive symptoms and cognitive decline over time remains challenging.
Добавил в систему: Гамалея Анна Александровна

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