Chronic Disease

Stimulation of the subthalamic nucleus of the brain improves quality of life for patients with advanced Parkinson's disease

Patients with advanced Parkinson's disease (PD) eventually have difficulty walking, talking, or completing simple tasks, with some having very limited or no mobility. According to a new study, however, patients with PD who underwent brain stimulation surgery reported improved quality of life. Up to 18 months after surgery, the patients had improvements in mobility, ability to carry out daily activities, and emotional well-being. They also felt less social stigma due to obviously rigid and unbalanced movements and less bodily discomfort.

The surgery, stimulation of the subthalamic nucleus (STN) of the brain, is accomplished by implanting a thin electrode into the brain. Small electrical pulses from a device similar to a cardiac pacemaker stimulate the brain and block brain signals that cause Parkinson's symptoms. This surgery is usually performed when patients' symptoms have failed to respond to anti-Parkinsonian medications or if they cannot tolerate side effects such as tics or hallucinations, notes Andrew Siderowf, M.D., M.S.C.E., of the University of Pennsylvania School of Medicine.

Dr. Siderowf and fellow researchers examined the responses of 18 patients with advanced PD to the Parkinson's Disease questionnaire-39 (PDQ-39), a general health status survey, and the EuroQol visual analogue scale (VAS) before surgery, 6 months after surgery, and 18 to 57 months after surgery. The VAS and all but three symptom domains of the PDQ-39 showed marked improvements at 6 months after surgery. At the long-term followup, there was a 63 percent sustained improvement in the VAS and—based on the PDQ-39—20 percent improved mobility, 29 percent improved ability to carry out activities of daily living, 26 percent improved emotional well-being, 43 percent fewer feelings of social stigma, and a 35 percent decline in bodily discomfort. Early improvement was strongly linked to long-term improvement. The study was supported by the Agency for Healthcare Research and Quality (HS00004).

See "Long-term effects of bilateral subthalamic nucleus stimulation on health-related quality of life in advanced Parkinson's disease," by Dr. Siderowf, Jurg L. Jaggi, Ph.D., Sharon X. Xie, Ph.D., and others in the June 2006 Movement Disorders 21(6), pp. 746-753.

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