Subthalamic Nucleus (STN) Deep-Brain Stimulation (DBS) in the Management of Idiopathic Parkinson's Disease: Results of our First 20 Cases

Abstract
Background: Idiopathic Parkinson's Disease (iPD) is one of the most disabling chronic neurologic diseases and leads to a significant loss of quality of life. Interest in surgical therapy for PD was renewed in the early 1990s. The most common functional stereotactic procedures that are performed worldwide for PD are lesioning and Deep-Brain Stimulation (DBS).
Aim of Study: Is to review and evaluate the results of STN-DBS in management of iPD in our first 20 patients.
Patients and Methods: This study was conducted in Department of Neurosurgery, Tanta University from January 2007 to March 2014. It included 20 patients with iPD, they must had positive L-dopa challenge test with at least a 33% decrease in the UPDRS III score. All patients were assessed by UPDRS in off and on phases. Stereotactic STN-DBS was done. The total off UPDRS III score was considered the primary outcome measurement.
Results: We had 14 males and 6 females with a mean age at PD onset of 46.5 years, a mean age at implant of 54.5 years with mean duration of symptoms of 10 years. 14 patients had moderate PD while 6 patients had severe PD. The post-operative OFF and ON UPDRS III score improved by 45.5%, and 63.9% respectively. The post-operative OFF and ON bradykinesia score improved by 55.5%, and 62.9% respec-tively. The post-operative OFF and ON tremor score was improved by 68.01% and 76.5% respectively. The post-operative OFF and ON rigidity score was improved by 71.81% and 78.8%. The post-operative OFF and ON postural instability and gait score was improved by 45.42% and 61.9% respec-tively. 60% of patients had good outcome and 40% had fair outcome. We reported one transient post-operative confusion, one infection, one lead displacement, and one lead fracture. Dyskinesia occurred in two patients, speech problems in two patients and emotional lability in one patient.
Conclusion: Bilateral STN-DBS provides significant symptom relief for the majority of well-screened patients with iPD.