Objective:  To show the degree, onset and longevity of benefit achieved with STN DBS at our center.

Background: At our center, we administer the UPDRS-III at nearly every patient visit. Now, we report the results from those, who underwent STN DBS implantation between 2 and 3 years ago. We wished to replicate Weaver et al., (2009) who showed that DBS with medical management outperformed medical management alone 6 months post-DBS. We also looked for the “micro-lesion” effect reported by Mann et al., (2009).

Methods: We reviewed the charts of 20 patients, who underwent STN DBS and were followed continuously. We aggregated all the “On” UPDRS-III scores during the year prior to STN DBS, as well as logged the “On” and “Off” scores of the Dopamine (Da) Challenge done during DBS candidacy. Subsequent to DBS, we logged the UPDRS-III score at the start of the Contact Screen, when patients came in during the “Off” state. We noted the UPDRS-III score during the visit immediately following the contact screen, and then aggregated the remaining “On” scores during the 3 and 6 month intervals, and subsequently for all 6 month intervals up to 2.5 years. Comparisons were made using paired ttests.

Results: The micro-lesion effect was assessed by comparing the Da Challenge “Off” score to the Contact screen “Off” score, revealing that the post-DBS “Off” score was statistically less than the pre-DBS “Off” score (t₍₁₉₎=2.41; p=0.026). No difference was found between the average UPDRS-III “On” score preceding DBS versus the Da Challenge “On” score (p=0.18). Consequently, these two scores were averaged to form a pre-DBS baseline “On” score to compare to the post-DBS “On” scores. Baseline “On” scores were then contrasted to: 1^st visit post-Contact screen (p=0.35), 3 month post DBS (p=0.04), 6 month (p=0.002), 1year (p=0.00003), 1.5 years (p=0.0006), 2 years (p=0.002), and 2.5 years (p=0.003). All statistical differences favored the post-DBS intervals with better UPDRS-III “On” scores than the pre-DBS baseline “On” score. 

Conclusions: Results from our long term STN DBS Parkinson’s patients verifies the “micro-lesion” effect, and further shows that benefit greater than best medical management alone can be obtained from DBS and best medical management by as early as 3 months post-DBS, and is maintained for at least 2.5 years post DBS. 

References: Weaver, F. M., et al. “Bilateral Deep Brain Stimulation Vs Best Medical Therapy for Patients with Advanced Parkinson Disease a Randomized Controlled Trial.” Jama-Journal of the American Medical Association 301.1 (2009): 63-73. 

Mann, J. M., et al. “Brain penetration effects of microelectrodes and DBS leads in STN or GPI.” Journal of Neurology, Neurosurgery & Psychiatry 80 (2009): 794-798. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/degree-onset-and-longevity-of-benefit-achieved-with-deep-brain-stimulation-dbs-of-the-subthalamic-nucleus-stn-as-assessed-by-the-updrs/