Byline: Guo-Xiong. Cheng, Shu-Bin. Yin, Ying-Hao. Yang, Yuan-Hu. Hu, Chih-Yang. Huang, Qian-Ming. Yao, Wei-Jen. Ting
Deep brain stimulation of the bilateral subthalamic nucleus (STN) is a therapeutic option for patients with Parkinson's disease (PD) in whom medical therapies have been ineffective. This retrospective cohort study analyzed the motor function of 27 patients with advanced PD, from the First Affiliated Hospital of Guangzhou Medical University, China, who received deep brain stimulation of the bilateral subthalamic nucleus and evaluated its therapeutic effects. The 10-year follow-up data of patients was analyzed in Qingyuan People's Hospital, Sixth Affiliated Hospital of Guangzhou Medical University, China. The follow-up data were divided into two categories based on patients during levodopa treatment (on-medication) and without levodopa treatment (off-medication). Compared with baseline, the motor function of on-medication PD patients improved after deep brain stimulation of the bilateral subthalamic nucleus. Even 2 years later, the motor function of off-medication PD patients had improved. On-medication PD patients exhibited better therapeutic effects over the 5 years than off-medication PD patients. On-medication patients' akinesia, speech, postural stability, gait, and cognitive function worsened only after 5 years. These results suggest that the motor function of patients with advanced PD benefitted from treatment with deep brain stimulation of the bilateral subthalamic nucleus over a period up to 5 years. The overall therapeutic effects were more pronounced when levodopa treatment was combined with deep brain stimulation of the bilateral subthalamic nucleus. This study was approved by Institutional Review Board of Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, China (approval No. QPH-IRB-A0140) on January 11, 2018.
Parkinson's disease (PD), a neurodegenerative condition characterized by motor dysfunction, causes behavioral, cognitive and psychiatric deficits in the affected patients (Peng and Zhao, 2016; Elvsåshagen et al., 2020; Qu et al., 2020; van de Weijer et al., 2020). Dysfunctions in the motor circuit that controls movements, the associative circuit that controls executive functions and the limbic circuit that controls emotions and motivation, contribute to the symptoms in PD patients (Rommelfanger and Wichmann, 2010; Goulding et al., 2020). The subthalamic nucleus (STN) is a structure in the basal ganglia involved in motor function and any modulation in the STN causes alteration in impulse control. Therefore, deep brain stimulation (DBS) of the STN in human patients has been reviewed and shown to be an effective treatment choice in patients with advanced PD (Choi et al., 2019). Long-term studies on STN stimulation show a clear effect on the cardinal motor symptoms of the disease for a notable period, however, the symptoms and PD conditions then deteriorate further (Jiang et al., 2015; Peng et al., 2018).
The basal ganglia of the striatum are strongly modulated by the neuromodulator, dopamine (Rommelfanger and Wichmann, 2010). However, the poor responses of motor symptoms to dopaminergic treatment cause postural instability and gait difficulties leading to substantial disabilities and reduced quality of life. STN-DBS would be expected to have a notable impact on such symptoms. Not all the effects of STN-DBS are clear; however, meta-analysis...