Share This Article:

Five-Year Outcomes of Bilateral Subthalamic Nucleus Stimulation in Japanese Patients with Parkinson’s Disease

Abstract Full-Text HTML XML Download Download as PDF (Size:366KB) PP. 21-27
DOI: 10.4236/apd.2015.42004    2,990 Downloads   3,610 Views   Citations


Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is widely performed for medically refractory Parkinson’s disease (PD). Several western studies have examined the long-term outcomes of STN DBS. However, the long-term outcomes in Japanese patients have not been reported. Methods: We studied the long-term outcomes of STN DBS in Japanese patients with PD. Fifty-five consecutive patients treated with bilateral STN DBS were followed for 5 years after surgery. Each patient underwent Unified Parkinson’s Disease Rating Scale assessments preoperatively and 1 and 5 years after surgery. Results: Twelve patients (22%) were lost to follow up within 5 years. Among them, 7 died and 5 became bed ridden because of PD deterioration. In the 43 patients followed for 5 years, STN DBS significantly improved motor function. The cardinal motor symptoms of tremor, rigidity, and bradykinesia in medication-on periods were significantly better than baseline 5 years after DBS. However, axial motor symptoms of speech, gait and postural stability gradually deteriorated and significantly worsened 5 years after DBS. Motor complications, including dyskinesia and motor fluctuations, significantly improved after DBS with a marked reduction in dopaminergic medication. These effects were maintained 5 years after DBS. Frequently, persisting adverse effects included apraxia of eyelid opening and dysarthria. Conclusions: STN DBS significantly improved motor symptoms in patients with advanced PD. These effects were maintained over 5 years in most patients. However, some showed rapid PD progression even after STN DBS. Other treatments for the axial symptoms and disease progression are needed in long-term PD treatment.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Umemura, A. , Miyata, M. , Oka, Y. , Okita, K. , Oyama, G. , Shimo, Y. and Hattori, N. (2015) Five-Year Outcomes of Bilateral Subthalamic Nucleus Stimulation in Japanese Patients with Parkinson’s Disease. Advances in Parkinson's Disease, 4, 21-27. doi: 10.4236/apd.2015.42004.


[1] Deuschl, G., Schade-Brittinger, C., Krack, P., Volkmann, J., Schäfer, H., Bötzel, K., Daniels, C., Deutschländer, A., Dillmann, U., Eisner, W., Gruber, D., Hamel, W., Herzog, J., Hilker, R., Klebe, S., Kloss, M., Koy, J., Krause, M., Kupsch, A., Lorenz, D., Lorenzl, S., Mehdorn, H.M., Moringlane, J.R., Oertel, W., Pinsker, M.O., Reichmann, H., Reuss, A., Schneider, G.H., Schnitzler, A., Steude, U., Sturm, V., Timmermann, L., Tronnier, V., Trottenberg, T., Wojtecki, L., Wolf, E., Poewe, W. and Voges, J., German Parkinson Study Group, Neurostimulation Section (2006) A Randomized Trial of Deep-Brain Stimulation for Parkinson’s Disease. The New England Journal of Medicine, 355, 896-908.
[2] Kleiner-Fisman, G., Herzog, J., Fisman, D.N., Tamma, F., Lyons, K.E., Pahwa, R., Lang, A.E. and Deuschl, G. (2006) Subthalamic Nucleus Deep Brain Stimulation: Summary and Meta-Analysis of Outcomes. Movement Disorders, 21, S290-S304.
[3] Krack, P., Batir, A., Van Blercom, N., Chabardes, S., Fraix, V., Ardouin, C., Koudsie, A., Limousin, P.D., Benazzouz, A., LeBas, J.F., Benabid, A.L. and Pollak, P. (2003) Five-Year Follow-Up of Bilateral Stimulation of the Subthalamic Nucleus in Advanced Parkinson’s Disease. The New England Journal of Medicine, 349, 1925-1934.
[4] Schüpbach, W.M., Chastan, N., Welter, M.L., Houeto, J.L., Mesnage, V., Bonnet, A.M., Czernecki, V., Maltête, D., Hartmann, A., Mallet, L., Pidoux, B., Dormont, D., Navarro, S., Cornu, P., Mallet, A. and Agid, Y. (2005) Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: A 5-Year Follow-Up. Journal of Neurology, Neurosurgery, and Psychiatry, 76, 1640-1644.
[5] Wider, C., Pollo, C., Bloch, J., Burkhard, P.R. and Vingerhoets, F.J. (2008) Long-Term Outcome of 50 Consecutive Parkinson’s Disease Patients Treated with Subthalamic Deep Brain Stimulation. Parkinsonism & Related Disorders, 14, 114-119.
[6] Gervais-Bernard, H., Xie-Brustolin, J., Mertens, P., Polo, G., Klinger, H., Adamec, D., Broussolle, E. and Thobois, S. (2009) Bilateral Subthalamic Nucleus Stimulation in Advanced Parkinson’s Disease: Five-Year Follow-Up. Journal of Neurology, 256, 225-233.
[7] Moro, E., Lozano, A.M., Pollak, P., Agid, Y., Rehncrona, S., Volkmann, J., Kulisevsky, J., Obeso, J.A., Albanese, A., Hariz, M.I., Quinn, N.P., Speelman, J.D., Benabid, A.L., Fraix, V., Mendes, A., Welter, M.L., Houeto, J.L., Cornu, P., Dormont, D., Tornqvist, A.L., Ekberg, R., Schnitzler, A., Timmermann, L., Wojtecki, L., Gironell, A., Rodriguez-Oroz, M.C., Guridi, J., Bentivoglio, A.R., Contarino, M.F., Romito, L., Scerrati, M., Janssens, M. and Lang, A.E. (2010) Long-Term Results of a Multicenter Study on Subthalamic and Pallidal Stimulation in Parkinson’s Disease. Movement Disorders, 25, 578-586.
[8] Fasano, A., Romito, L.M., Daniele, A., Piano, C., Zinno, M., Bentivoglio, A.R. and Albanese, A. (2010) Motor and Cognitive Outcome in Patients with Parkinson’s Disease 8 Years after Subthalamic Implants. Brain, 133, 2664-2676.
[9] Zibetti, M., Merola, A., Rizzi, L., Ricchi, V., Angrisano, S., Azzaro, C., Artusi, C.A., Arduino, N., Marchisio, A., Lanotte, M., Rizzone, M. and Lopiano, L. (2011) Beyond Nine Years of Continuous Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease. Movement Disorders, 26, 2327-2334.
[10] Castrioto, A., Lozano, A.M., Poon, Y.Y., Lang, A.E., Fallis, M. and Moro, E. (2011) Ten-Year Outcome of Subthalamic Stimulation in Parkinson Disease. Archives of Neurology, 68, 1550-1556.
[11] Umemura, A., Oka, Y., Yamada, K., Oyama, G., Shimo, Y. and Hattori, N. (2013) Validity of Single Tract Microelectrode Recording in Subthalamic Nucleus Stimulation. Neurologia medico-chirurgica (Tokyo), 53, 821-827.
[12] Jaggi, J.L., Umemura, A., Hurtig, H.I., Siderowf, A.D., Colcher, A., Stern, M.B. and Baltuch, G.H. (2004) Bilateral Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: Surgical Efficacy and Prediction of Outcome. Stereotactic and Functional Neurosurgery, 82, 104-114.
[13] Ngoga, D., Mitchell, R., Kausar, J., Hodson, J., Harries, A. and Pall, H. (2014) Deep Brain Stimulation Improves Survival in Severe Parkinson’s Disease. Journal of Neurology, Neurosurgery, and Psychiatry, 85, 17-22.
[14] Lilleeng, B., Brønnick, K., Toft, M., Dietrichs, E. and Larsen, J.P. (2014) Progression and Survival in Parkinson’s Disease with Subthalamic Nucleus Stimulation. Acta Neurologica Scandinavica, 130, 292-298.
[15] Umemura, A., Oka, Y., Yamamoto, K., Okita, K., Matsukawa, N. and Yamada, K. (2011) Complications of Subthalamic Nucleus Stimulation in Parkinson’s Disease. Neurologia medico-chirurgica, 51, 749-755.
[16] Parsons, T.D., Rogers, S.A., Braaten, A.J., Woods, S.P. and Tröster, A.I. (2006) Cognitive Sequelae of Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease: A Meta-Analysis. The Lancet Neurology, 5, 578-588.

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.