Objective: To evaluate the efficacy and adverse effects of subthalamic deep brain stimulation (STN-DBS) in patients with advanced Parkinson’s disease (PD) and the possible correlation between electrode position and clinical outcome.

Background: STN-DBS is evidence-based option for the treatment of advanced PD. DBS alleviates motor symptoms, improves the activities of daily living (ADL) and reduces levodopa induced dyskinesia. The possible correlation of the active electrode position in subthalmic nucleus and the clinical outcome is poorly investigated.

Methods: We retrospectively reviewed the medical records of 106 consecutive patients with advanced PD who received STN-DBS at Helsinki University Hospital (HUH) from 2006 to 2014. The changes of Unified Parkinson’s disease Rating Scale (UPDRS) part III score, antiparkinson medication dosage and adverse effects were studied. We estimated the location of the active electrode in three different ways: direct visual analysis of MRI correlated to Mai Atlas of Human brain, location in relation to the red nucleus borders and location in AC-PC coordinates.

Results: Compared to baseline, levodopa equivalent doses (LEDs) decreased 25 % (p<0.001) and UPDRS part III scores improved 37 % (p<0.001) at six months. Most frequent complications were dysarthria (23 %) and skin infections (14 %). Electrode coordinates in the three examined coordinate systems correlated well with each other. In patients with better clinical outcome, LED decrease, position of the active electrode was significantly more ventral than in those with worse outcome.

Conclusions: STN-DBS improves motor function and enables the reduction of antiparkinson medication at six months follow-up with an acceptable adverse effect profile. Electrode location seems to be related to clinical outcome.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-outcome-of-subthalamic-deep-brain-stimulation-in-parkinsons-disease-the-helsinki-experience/