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Long-term motor outcomes of deep brain stimulation of the globus pallidus interna in Parkinson's disease patients: Five-year follow-up

  • Yun Su Hwang
    Affiliations
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea

    Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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  • Sungyang Jo
    Affiliations
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Seung Hyun Lee
    Affiliations
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Nayoung Kim
    Affiliations
    Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Mi-Sun Kim
    Affiliations
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Sang Ryong Jeon
    Affiliations
    Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Sun Ju Chung
    Correspondence
    Corresponding author at: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, South Korea.
    Affiliations
    Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Published:October 28, 2022DOI:https://doi.org/10.1016/j.jns.2022.120484

      Highlights

      • We investigated the long-term motor outcomes in PD patients at 5 years after GPi-DBS.
      • GPi-DBS provides long-term beneficial effects against tremor, motor fluctuation and LID.
      • However, PIGD symptoms gradually worsen after improvement by GPi-DBS.
      • Preoperative levodopa response was associated with the long-term benefits on PIGD symptoms.
      • This selective long-term benefit has implications for the optimal application of DBS in PD patients.

      Abstract

      Background

      Deep brain stimulation (DBS) of globus pallidus interna (GPi) is an established treatment for advanced Parkinson's disease (PD). However, in contrast to subthalamic nucleus (STN)-DBS, long-term outcomes of GPi-DBS have rarely been studied.

      Objective

      We investigated the long-term motor outcomes in PD patients at 5 years after GPi-DBS.

      Methods

      We retrospectively analyzed the clinical data for PD patients who underwent GPi-DBS. Longitudinal changes of UPDRS scores from baseline to 5 years after surgery were assessed.

      Results

      Forty PD patients with a mean age of 59.5 ± 7.9 years at DBS surgery (mean duration of PD: 11.4 ± 3.4 years) were included at baseline and 25 patients were included in 5-year evaluation after DBS. Compared to baseline, sub-scores for tremor, levodopa-induced dyskinesia (LID), and motor fluctuation indicated improved states up to 5 years after surgery (p < 0.001). However, UPDRS Part 3 total score and sub-score for postural instability and gait disturbance (PIGD) gradually worsened over time until 5 years after surgery (p > 0.017 after Bonferroni correction). In a logistic regression model, only preoperative levodopa response was associated with the long-term benefits on UPDRS Part 3 total score and PIGD sub-score (OR = 1.20; 95% CI = 1.04–1.39; p = 0.015 and OR = 4.99; 95% CI = 1.39–17.89; p = 0.014, respectively).

      Conclusions

      GPi-DBS provides long-term beneficial effects against tremor, motor fluctuation and LID, but PIGD symptoms gradually worsen. This selective long-term benefit has implications for the optimal application of DBS in PD patients.

      Keywords

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