Chronic Electrostimulation of the Subthalamic Nucleus in an Akineticorigid Form of Parkinsonís Disease

Tomskiy ņ.*, Shabalov V.*, Bril Ň.**, Fedorova N.***

* Burdenko Research Institute of Neurosurgery, Moscow, Russia;
** Department of Neurology Russian Medical Academy of Postgraduate Education, Moscow, Russia;
*** Centre of Extrapyramidal Pathology, Russian Medical Academy of Postgraduate Education, Moscow, Russia

 

The research goal was to estimate continuous electrostimulation of the subthalamic nucleus (ES STN) in Parkinsonís disease (PD) with leading akineticorigid syndrome.

Material and Methods. The results of ES STN, carried out in 15 cases with an akineticorigid form of PD, were analyzed. A mean age and duration of the disease were 54.2±9.8 and 9.8±3.6 years respectively. The patients took DSS during several years (7.3±3.6); an average daily dose was 886.7±505.9 mg. A degree of severity according to Hoehn and Yahr was as follows: 3 - 5 cases, 4 - 8 cases, 5 - 2 cases. Motor disorders, everyday activity and life quality were analyzed on the basis of UPDRS-II and III, Schwab and England scale and PDQ-39 questionnaire respectively. The cases were examined before operation against a background of no DSS effect (OFF-med.), at the height of its effect (ON-med.) and 6 months later under analogous conditions. Dyskinesias and fluctuations were studied with the help of UPDRS-IV and BSF.

Results. ES STN led to a reliable reduction of severity of motor disorders (tremor, rigidity, hypokinesia, postural disturbances) both in OFF-med. and ON-med. states. It reduced by 45.2% (OFF-med.) and 25.4% (ON-med.). Everyday activity increased by 29.5% (OFF-med.) and 9.6% (ON-med.). Though a daily dose of DSS decreased by 55.4%, there was better control of motor disorders. There was reliable regression of dyskinesias and fluctuations (by 69.3%). Indices of life quality improved in 14 cases.

Conclusion. Treatment of an akineticorigid form of PD with ES STN is effective. This method allows to reduce severity of motor symptoms, a daily dose of DSS and a degree, to which complications of drug therapy are marked.