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a Centre
d'Investigation Clinique, Fédération de Neurologie and INSERM
U289, France, b Département de
Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France, c Departement de
Neurologie, Hôpital Hôtel-Dieu de France, USJ, Beirut, Lebanon
Correspondence to: Dr Yves Agid, Centre d'Investigation Clinique, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France cic.salpetriere{at}psl.ap-hop-paris.fr
Received 20 May 1999;
Accepted 3 September 1999
OBJECTIVE
To assess
the effects of high frequency stimulation of the subthalamic nucleus
(STN) on axial symptoms occurring in advanced stages of Parkinson's
disease (PD).
METHODSThe efficacy
of STN stimulation on total motor disability score (unified
Parkinson's disease rating scale (UPDRS) part III) were evaluated in
10 patients with severe Parkinson's disease. The subscores were then
studied separately for limb akinesia, rigidity, and tremor, which are
known to respond to levodopa, and axial signs, including speech, neck
rigidity, rising from a chair, posture, gait, and postural stability,
which are known to respond less well to levodopa. Patients were
clinically assessed in the "off" and "on" drug condition during
a levodopa challenge test performed before surgical implantation of
stimulation electrodes and repeated 6 months after surgery under
continuous STN stimulation. A complementary score for axial symptoms
from the "activities of daily living" (ADL)that is, speech,
swallowing, turning in bed, falling, walking, and freezingwas
obtained from each patient's questionnaire (UPDRS, part II).
RESULTSImprovements
in total motor disability score (62%), limb signs (62%), and axial
signs (72%) obtained with STN stimulation were statistically
comparable with those obtained with levodopa during the preoperative
challenge (68%, 69%, and 59%, respectively). When levodopa and STN
stimulation were combined there was a further improvement in total
motor disability (80%) compared with preoperative levodopa
administration. This consisted largely of an additional improvement in
axial signs (84%) mainly for posture and postural stability, no
further improvement in levodopa responsive signs being found. Axial
symptoms from the ADL showed similar additional improvement when
levodopa and STN stimulation were combined.
CONCLUSIONThese
findings suggest that bilateral STN stimulation improves most axial
features of Parkinson's disease and that a synergistic effect can be
obtained when stimulation is used in conjunction with levodopa treatment.
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