Dynamics of the Motor Symptoms of Parkinson’s Disease on the Background of Chronic Bilateral Electrical Stimulation of the Subthalamic Nucleus Using Two Methods to Verify Target Structure
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Objectives. To determine the efficacy of electrical stimulation of the subthalamic nucleus using different methods to verify target structure in patients with Parkinson’s disease based on assessment of the dynamics of motor symptoms. Materials and methods. A total of 60 patients with PD with chronic bilateral electrical stimulation of the subthalamic nucleus (ES of the STN) were studied. Multichannel microelectrode recording (MER) was performed during neurostimulation electrode implantation surgery in 30 cases. Intraoperative MER was not performed in 30 cases. The control group consisted of 30 patients with PD who received only conservative medication-based treatment. Patient investigations used the Hoehn and Yahr scale, the Tinetti Balance and Mobility Scale (TBMS), the Unifi ed Parkinson’s Disease Rating Scale (UPDRS), the PDQ-39 quality of life self-assessment scale for Parkinson’s disease, and the Schwab and England Activities of Daily Living (ADL) scale. The levodopa equivalent daily dose (LEDD) was determined individually for each patient. Results and conclusions. ES of the STN was found to be effective when used in combination with MER in terms of effects on the severity of the main motor symptoms, motor complications, gait, and measures of quality of life and the activities of daily living. On the background of ES of the STN, patients of both surgical groups attained significant reductions in LEDD with marked improvements in the control of the motor symptoms of PD; significant decreases in the severity of motor fluctuation (50%) and peak dose iatrogenic dyskinesias (51%) were seen. Measures of quality of life and the activities of daily living while off medication improved significantly in both groups of patients receiving ES of the STN independently of the intraoperative target selection technique (75–100%) as compared with the control group.
KeywordsParkinson’s disease chronic bilateral electrical stimulation of the subthalamic nucleus microelectrode recording motor symptoms
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