Objective: To assess and compare the long-term motor and functional outcome of subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) in treatment of patients with advanced Parkinson’s disease (PD).

Background: DBS STN and GPi are effective for treatment of levodopa-responsive symptoms, motor fluctuations and dyskinesias in advanced PD. Several previous trials delivered ambiguous results concerning comparison of motor and functional outcomes as well as possible affective and cognitive complications following both methods.

Methods: We evaluated 40 patients with advanced PD (Hoehn&Yahr stage 3.4±0.6). 25 patients received DBS STN (age at surgery 53.4±7.3 years; disease duration 12.0±3.6 years). 15 patients received DBS GPi (age at surgery 54.2±13.4 years; disease duration 11.3±5.4 years). Groups had no significant differences in clinical scoring. LEDD and L-dopa dose in DBS STN were higher. We assessed clinical outcome (UPDRS), quality of life (PDQ-39), antiparkinsonian medication regimen (levodopa dose and L-dopa equivalent daily dose) under continuous DBS at the time point of 1, 3 and 5 years postoperatively.

Results: Both DBS STN and GPi improved significantly PD symptoms in off-medication state and reduced complications of L-dopa therapy up to 3-year follow-up. Absolute decrease in UPDRS motor score was higher in DBS STN group (28.8±14.7 and 45.5% vs. 15.3±14.6 and 26.5%, p<0.05). DBS GPi was less effective in long-term follow-up; off-state UPDRS III score in the 5th year approached preoperative. Motor improvement (off) in DBS STN remained significant during entire follow-up. In DBS GPi, motor symptoms in on-medication state deteriorated significantly over the time. In DBS STN, on-state was initially improving with further slight decline not exceeding preoperative level. DBS STN provided stable reduction in LEDD (-35.5±32.8% after 5 years). In DBS GPi, LEDD tended to increase (25.3±31.1% after 5 years). PDQ-39 quality of life remained improved to the 5th year in DBS STN (11.3%). In DBS GPi, PDQ-39 score was ameliorated only in the first year of follow-up. 

Conclusions: DBS STN should be regarded as an advantageous method in advanced PD patients with severe motor fluctuations, high L-dopa dose, and excellent L-dopa response. DBS GPi might be still an option in patients with less L-dopa response or severe dyskinesias at low L-dopa dose. In the long-term, quality of life is crucial.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-subthalamic-and-pallidal-deep-brain-stimulation-in-treatment-of-parkinsons-disease-a-5-year-follow-up-study/