Iranian Journal of Neurology 2017. 16(3):107-111.

Outcome of subthalamic nucleus deep brain stimulation on long-term motor function of patients with advanced Parkinson disease
Gholam Ali Shahidi, Mohammad Roohani, Mansour Parvaresh, Bahram Haghi-Ashtiani, Maryam Saeeedi, Romina Rashedi, Zeynab Noori-Motlagh


Background: The objective of our study was to assess Unified Parkinson Disease Rating Scale (UPDRS) score in Parkinson disease (PD) patients who underwent subthalamic nucleus (STN) deep brain stimulation (DBS) 6 years after their surgery and to compare their UPDRS score 6 years after DBS with their score before surgery and 6 months after their operation.

Methods: In this cross sectional study which was carried out at Neurology Department of Rasool-e-Akram Hospital, Tehran, Iran, affiliated to Iran University of Medical Sciences between 2008 and 2014, 37 patients with advanced PD were enrolled using non-randomized sampling method. All of the patients underwent STN DBS surgery and one patient died before being discharged, therefore; we started our study with 36 patients. The UPDRS III total score at preoperative state, 6-month follow-up and 6-year follow-up state were compared using repeated-measure analysis of variance.

Results: Thirty-seven patients (26 men and 10 women) with mean age of 50 ± 3 ranging from 32 to 72 years underwent STN DBS surgery. All patients were suffering from advanced PD with mean period of 11.3 ± 1.9 years. All patients except one were followed up for six months. And 14 patients (8 men and 6 women) were included in a six-year follow-up. The UPDRS score measurements before surgery, at
6-month follow-up and 6-year follow-up were
18.22 ± 2.88, 12.80 ± 3.14, 25.0 ± 11.8, respectively. Significant increase in UPDRS score was observed between the preoperative and six-year follow-up period (P < 0.001).

Conclusion: In conclusion, this study suggests that total UPDRS score will increase at 5 years following STN DBS and also showed that resting tremor, one of UPDRS sub-scores, will improve over time and the benefit of DBS will be persistent even after 6 years.


Parkinson Disease; Deep Brain Stimulation; UPDRS

Full Text:



Fahn S, Przedborski S (2000) Parkinsonism. In: Rowland LP, editor. Merrit's Neurology. Merritt's Neurology ed. New-York: Lippincott Williams & Wilkins. pp. 679–693.

Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008;79:368-376.

Fahn S. The medical treatment of Parkinson disease from James Parkinson to George Cotzias. Mov Disord. 2015 Jan;30(1):4-18.

Mazzucchi S, Frosini D, Bonuccelli U, Ceravolo R. Current treatment and future prospects of dopa-induced dyskinesias. Drugs Today (Barc). 2015 May;51(5):315-29.

Pandey S, Sarma N. Deep brain stimulation: current status. Neurol India. 2015 Jan-Feb;63(1):9-18.

Kumar R, Lozano AM, Kim YJ, Hutchison WD, Sime E, Halket E, et al. Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 1998;51(3): 850-5.

Vingerhoets FJ, Villemure JG, Temperli P, Pollo C, Pralong E, Ghika J. Subthalamic DBS replaces levodopa in Parkinson's disease: two year follow-up. Neurology 2002;58(3):396-401.

Krack P, Batir A, Van BN, Chabardes S, Fraix V, Ardouin C, et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 2003;349(20): 1925-34.

Visser-Vandewalle V, van der LC, Temel Y, Celik H, Ackermans L, Spincemaille G, et al. Long-term effects of bilateral subthalamic nucleus stimulation in advanced Parkinson disease: a four year follow-up study. Parkinsonism Relat Disord 2005;11(3):157-65.

Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P,Rehncrona S, et al. Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up. Brain 2005;128 (Pt 10):2240-9.

Bari AA, Fasano A, Munhoz RP, Lozano AM. Improving outcomes of subthalamic nucleus deep brain stimulation in Parkinson's disease. Expert Rev Neurother. 2015 Oct;15(10):1151-60.

Kleiner-Fisman G, Herzog J, Fisman DN, Tamma F, Lyons KE, Pahwa R, etal. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006 Jun;21 Suppl 14:S290-304.

Alamri A, Ughratdar I, Samuel M, Ashkan K. Deep brain stimulation of the subthalamic nucleus in Parkinson's disease 2003-2013: Where are we another 10 years on?. Br J Neurosurg. 2015 Jun;29(3):319-28.

Deuschl G, Paschen S, Witt K. Clinical outcome of deep brain stimulation for Parkinson's disease. Handb Clin Neurol. 2013;116:107–28.

Cioni B. Motor cortex stimulation for Parkinson's disease. Acta Neurochir Suppl. 2007;97(Pt 2):233-8.

Pagni CA, Albanese A, Bentivoglio A, Broggi G, Canavero S, Cioni B, et al. Results by motor cortex stimulation in treatment of focal dystonia, Parkinson's disease and post-ictal spasticity. The experience of the Italian Study Group of the Italian Neurosurgical Society. Acta Neurochir Suppl. 2008;101:13-21.

Zrinzo L, Holl EM, Petersen EA, Limousin P, Foltynie T, Hariz MI. Skewering the subthalamic nucleus via a parietal approach. Stereotact Funct Neurosurg. 2011;89(2):70-5.

Lukins TR, Tisch S, Jonker B. The latest evidence on target selection in deep brain stimulation for Parkinson's disease. J Clin Neurosci. 2014 Jan;21(1):22-7.

Lu-Lu Jiang, Jin-Long Liu, Xiao-Li Fu, Wen-Biao Xian, Jing Gu, Yan-Mei Liu, et al. Long-term Efficacy of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A 5-year Follow-up Study in China. Chin Med J (Engl). 2015 Sep 20; 128(18): 2433–2438.

Michael S Okun ,Kelly D Foote. Parkinson’s disease DBS: what, when, who and why? The time has come to tailor DBS targets. Expert Rev Neurother. 2010 Dec; 10(12): 1847–1857.

Qi Wei Oung, Hariharan Muthusamy, Hoi Leong Lee, Shafriza Nisha Basah, Sazali Yaacob, Mohamed Sarillee, et al. Technologies for Assessment of Motor Disorders in Parkinson’s Disease: A Review. Sensors (Basel). 2015 Sep; 15(9): 21710–21745.

Bahram Haghi-Ashtiani, Gholmali Shahidi , Mohammad Rohani , Mehdi Jalili, Farzad Sina . Early outcome of subthalamic nucleus deep brain stimulation (STN-DBS) in advanced parkinson disease in first trial of Iranian patients. Medical Journal of the Islamic Republic of Iran.Vol. 23, No. 3, November, 2009. pp. 122-127.

Gervais-Bernard H, Xie-Brustolin J, Mertens P, Polo G, Klinger H, Adamec D, et al. Bilateral subthalamic nucleus stimulation in advanced Parkinson's disease: Five year follow-up. J Neurol.2009;256:225–33.

Fasano A, Romito LM, Daniele A, Piano C, Zinno M, Bentivoglio AR, et al. Motor and cognitive outcome in patients with Parkinson's disease 8 years after subthalamic implants. rain.2010;133:2664–76.

Zibetti M, Merola A, Rizzi L, Ricchi V, Angrisano S, Azzaro C, et al. Beyond nine years of continuous subthalamic nucleus deep brain stimulation in Parkinson's disease. Mov Disord.2011;26:2327–34.

Castrioto A, Lozano AM, Poon YY, Lang AE, Fallis M, Moro E. Ten-year outcome of subthalamic stimulation in Parkinson disease: A blinded evaluation. Arch Neurol. 2011;68:1550–6.

Lilleeng B, Gjerstad M, Baardsen R, Dalen I, Larsen JP. Motor symptoms after deep brain stimulation of the subthalamic nucleus. Acta Neurol Scand. 2015;131:298–304.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.