Figura. a) Resonancia magnética en corte axial, secuencia T1, que muestra la colocación de electrodos de estimulación cerebral profunda bilaterales en su trayecto hacia el núcleo subtalámico; b) Corte sagital, secuencia T2, que muestra la trayectoria de un electrodo de estimulación cerebral profunda en el núcleo subtalámico para la enfermedad de Parkinson idiopática.
Bilateral two-stage implantation for deep brain stimulation in the treatment of bilateral idiopathic Parkinson’s disease: clinical outcomes
Aims. Simultaneous bilateral implantation of electrodes in the subthalamic nucleus for idiopathic Parkinson’s disease (IPD) is associated with long surgery time, language disorders and post-operative confusion. Moreover, there is evidence of ipsilateral improvement after stimulation of the subthalamic nucleus. In order to optimise perioperative management a prospective study is conducted with deep brain stimulation (DBS) in the subthalamic nucleus in two consecutive unilateral procedures.
Patients and methods. We conducted a prospective study of 41 patients with bilateral IPD, with DBS implantation in two unilateral surgical phases. Its clinical outcomes are analysed according to the Unified Parkinson’s Disease Rating Scale (UPDRS), the Hoehn & Yahr, and the Schwab & England scales, together with their complications.
Results. The mean age was 61 ± 7 years old, 23 males. Five patients (12%) did not undergo surgery of the contralateral subthalamic nucleus due to good control. The mean on the motor UPDRS and the Hoehn & Yahr in preoperative pharmacological off was 44 ± 14 and 3, respectively, and 19 ± 8 and 1.8 at six months’ follow-up. The mean improvement on the Schwab & England scale in the pre-operative period and at six months was 39%. Two patients suffered post-operative confusion, and one of them had transient dysarthria.
Conclusions. Bilateral DBS in two unilateral stages was an effective option with few complications in our series of patients with IPD. 10% of the patients did not require contralateral electrodes. It would be necessary to conduct a randomised study in patients who underwent bilateral surgery in one and two stages in order to confirm these results.
Key words. Deep brain stimulation. Dysarthria. Parkinson’s disease. Post-operative confusion. Subthalamic nucleus. Unilateral implantation.