Gholam Ali Shahidi, Mohammad Rohani, Bahram Haghi, Javad Moghimi.
Early outcome of subthalmic nucleus - deep brain stimulation (STN-DBS) in the advanced stage of parkinson disease - a trial of Iranian patients.
Pak J Neurological Sci Jan ;5(1):10-4.

Introduction: To improve the debilitating features of Parkinson disease (PD) various medical and surgical approaches are available. Subthalamic nucleus deep brain stimulation (STN-DBS) was appeared to be a promising method during last two decades. This study aimed to evaluate early motor outcomes of this procedure in one of the first trials of Iranian patients. Materials and Methods: Thirty-seven patients with advanced Parkinson disease, unresponsive to common medical agents, underwent bilateral STN-DBS. For assessment of motor function parameters “Unified Parkinson Disease Rating Scale III” (UPDRS III) was used. We compared total scores and sub-scores in three categories performed as 1) preoperative off-medication, 2) preoperative on-medication and 3) six months postoperative on medication. Reduction in drug consumption was assessed considering administered doses of l-dopa before and after surgery in stable states. Results: Twenty six males and 10 females with mean age of 50 years were evaluated (one patient expired before 6-month followup). Mean total scores of UPDRSIII were 5.2±54.52, 2.88±18.22 and 3±12.8 in the three categories, respectively (p=0.003). PostHoc analyses showed significant improvement among all categories. Analysis of sub-scores also revealed significant amelioration in rigidity, action tremor, hand movement, leg agility, finger tap and rapid alternating movement in on-medication phases of pre- and post-operation (all with p<0.01). Mean dosage administered of l-dopa were224±1296 mg/d and 174±782 mg/d before and after surgery, significant decline was observed. (p<0.001). Conclusion: Our results indicated that bitemporal STN-DBS can result in significant short-term improvement of the motor symptoms especially in debilitating symptoms such as rigidity and tremor in advanced PD. It also accompanies with remarkable reduction in the needed doses of drugs. The findings support other studies with similar follow-up interval; however, continuous evaluations are needed for long-lasting results.

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