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Assessment of the effects of unilateral electrode dysfunction in patients with Parkinson disease undergoing bilateral subthalamic nucleus deep brain stimulation

 Park, Young Seok  ;  Kim, Joo Pyung  ;  Chang, Won Seok  ;  Lee, Phil Hyu  ;  Sohn, Young Ho  ;  Chang, Jin Woo 
 Neurosurgery, Vol.70(1 Suppl Operative) : 163-169, 2012 
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BACKGROUND: Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is the gold standard surgical treatment for medically intractable Parkinson disease, and unilateral electrodes are reported to have beneficial effects. However, assessment of patients after electrode failure needs to be established. OBJECTIVE: To assess the effects of the remaining unilateral electrode in Parkinson disease after bilateral STN-DBS. METHODS: Between May 2000 and March 2009, 8 patients had unilateral STN-DBS after bilateral STN-DBS. We assessed clinical outcome by comparing the Unified Parkinson Disease Rating Scale (UPDRS) motor score, activities of daily living, levodopa-equivalent daily dosages, and quality of life according to the Short-Form 36 Health Survey between patients with unilateral and bilateral electrodes. RESULTS: Although ipsilateral and axial UPDRS motor scores were compromised, UPDRS motor scores contralateral to the side of the implant remained unaltered after removal of 1 electrode. Although physical aspects of quality of life declined significantly with a unilateral electrode, pain and social functioning were not significantly affected. No significant changes in activities of daily living, Hoehn and Yahr stage, or levodopa-equivalent daily dosage were observed after removal of 1 electrode. CONCLUSION: The UPDRS motor score with unilateral STN-DBS was compromised relative to bilateral STN-DBS for ipsilateral motor and axial symptoms. When 1 electrode is compromised, revision of that electrode will eventually be required, but not immediately in all patients. If a patient tolerates loss of 1 electrode according to motor score while maintaining activities of daily living and quality of life, it is possible to wait and observe the situation instead of immediately revising the electrode.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실)
Yonsei Authors
김주평(Kim, Joo Pyung)
박영석(Park, Young Seok)
손영호(Sohn, Young Ho) ORCID logo https://orcid.org/0000-0001-6533-2610
이필휴(Lee, Phil Hyu)
장원석(Chang, Won Seok)
장진우(Chang, Jin Woo) ORCID logo https://orcid.org/0000-0002-2717-0101
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