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

Young Seok Park, Joo Pyung Kim, Won Seok Chang, philhyu Lee, Young Ho Sohn, JinWoo Chang

Research output: Contribution to journalArticle

Abstract

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 levodopaequivalent 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.

Original languageEnglish
Pages (from-to)163-169
Number of pages7
JournalOperative Neurosurgery
Volume70
Issue number1
DOIs
Publication statusPublished - 2012 Jan 1

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Subthalamic Nucleus
Deep Brain Stimulation
Parkinson Disease
Electrodes
Activities of Daily Living
Quality of Life
Levodopa
Health Surveys
Motor Activity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

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title = "Assessment of the effects of unilateral electrode dysfunction in patients with parkinson disease undergoing bilateral subthalamic nucleus deep brain stimulation",
abstract = "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 levodopaequivalent 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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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, philhyu; Sohn, Young Ho; Chang, JinWoo.

In: Operative Neurosurgery, Vol. 70, No. 1, 01.01.2012, p. 163-169.

Research output: Contribution to journalArticle

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AU - Kim, Joo Pyung

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AU - Lee, philhyu

AU - Sohn, Young Ho

AU - Chang, JinWoo

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N2 - 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 levodopaequivalent 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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