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Long term follow-up in advanced Parkinson’s disease treated with DBS of the subthalamic nucleus

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Abstract

Background

Parkinson’s disease (PD) is the second most common neurodegenerative disorder, affecting both motor and non-motor systems. Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been an approved treatment for PD for more than 30 years, but few data are available regarding its long-term effectiveness.

Objective

The aim of this study is to evaluate patients’ outcome, both from a motor and non-motor perspective, 9 to 14 years after DBS implantation. We have investigated patients with advanced PD and treated with STN-DBS, in relation to key clinical features of PD.

Methods

18 patients were assessed both retrospectively and prospectively. They underwent motor examination, neuropsychological evaluation and questionnaires on the quality of life, preoperatively, as well as 1, 9 and 14 years after DBS surgery. All patients were implanted with STN-DBS at San Raffaele Hospital between 2004 and 2010.

Results

13 males and five females underwent DBS implantation with a mean PD duration of 11 years. Stimulation significantly improved med-off/stim-on condition up to 9 years, compared to the preoperative off state, and med-on/stim-on condition at 14 years, compared to med-on/stim-off state. Long term improvement specifically involved tremor and rigidity, as well as dopaminergic daily dose. At the same time, STN-DBS had no long-lasting effect on axial symptoms and cognitive functions.

Conclusions

STN-DBS remains an effective therapy for advanced PD, also over the years. Despite the underlying progression of the disease, this treatment extends the period in which the overall quality of life is still acceptable.

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Availability of data and material

Data and material are available on request.

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Acknowledgements

We thank F. Spagnolo, D. Ceppi, S. Lalli, M. Fichera, R. Balestrino, E. Bonavertura, M. Impellizzeri, P. Picozzi, A. Franzin; and patients, caregivers and volunteers for their participation in our research.

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Author information

Authors and Affiliations

  1. Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Maria Antonietta Volonté, Giacomo Clarizio, Sebastiano Galantucci, Pietro Giuseppe Scamarcia, Rosalinda Cardamone, Monica Falautano & Massimo Filippi

  2. Neurosurgery and Radiosurgery Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Lina Raffaella Barzaghi & Pietro Mortini

  3. Vita-Salute San Raffaele University, Milan, Italy

    Giancarlo Comi & Massimo Filippi

  4. Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

  5. Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

  6. Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

Authors
  1. Maria Antonietta Volonté
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  2. Giacomo Clarizio
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  3. Sebastiano Galantucci
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  4. Pietro Giuseppe Scamarcia
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  5. Rosalinda Cardamone
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  6. Lina Raffaella Barzaghi
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  7. Monica Falautano
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  8. Pietro Mortini
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  9. Giancarlo Comi
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  10. Massimo Filippi
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Contributions

Authors whose names appear on the submission. MAV, GC, SG, PGS, RC, LRB, MF, PM: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; MF,PGS, SG, MAV: drafted the work or revised it critically for important intellectual content; MAV, GC, PGS, SG: approved the version to be published; MAV, PGS, SG, GC: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Massimo Filippi.

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Ethical Standards

The Study was approved by the Ethics Committe of IRCCS San Raffaele Scientific Institute, Milan, Italy. All Participants provided informed consent.

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Volonté, M.A., Clarizio, G., Galantucci, S. et al. Long term follow-up in advanced Parkinson’s disease treated with DBS of the subthalamic nucleus. J Neurol 268, 2821–2830 (2021). https://doi.org/10.1007/s00415-021-10430-y

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