Deep Brain Stimulation of the Subthalamic Nucleus in Advanced Parkinson Disease: Long-Term Motor Outcomes
DOI:
https://doi.org/10.5281/zenodo.22310326Keywords:
Subthalamic nucleus, Deep brain stimulation, Parkinson disease, Long-term outcomes, Levodopa-equivalent doseAbstract
Background: Subthalamic nucleus deep brain stimulation (STN-DBS) is an established surgical treatment for advanced
Parkinson disease (PD) with motor fluctuations and dyskinesia refractory to medical therapy. Objective: To synthesise published evidence on long-term (5-year and, where available, 10- to 20-year) motor outcomes ofSTN-DBS. Methods: Narrative review of randomized trials, long-term cohorts, meta-analyses, and consensus literature. Findings: Randomized trials show sustained gains in off-medication motor score, "on" time without troublesome dyskinesia, and roughly 50% reduction in levodopa-equivalent dose relative to medical therapy. Cohorts extending to 10-20 years confirm durable improvement in tremor, rigidity and dyskinesia, while axial, speech and cognitive domains progressively decline, consistent with disease progression rather than treatment failure. Hardware complications occur in roughly 5-10% of patients, and suicidality, though uncommon, is disproportionately elevated early after surgery.
Conclusions: STN-DBS confers durable, clinically meaningful motor benefit and medication-sparing effects across the long-term
literature, with outcome heavily modified by baseline levodopa responsiveness, age, and axial/cognitive status at implantation.
References
Limousin, P., Krack, P., Pollak, P., Benazzouz, A., Ardouin, C., Hoffmann, D., Benabid, A.L. (1998) Electrical Stimulation of the Subthalamic Nucleus in Advanced Parkinson's Disease. New England Journal of Medicine, 339(16): 1105-1111.
Deuschl, G., Schade-Brittinger, C., Krack, P., Volkmann, J., Schafer, H., Botzel, K., et al. (2006) A Randomized Trial of Deep-Brain Stimulation for Parkinson's Disease. New England Journal of Medicine, 355(9): 896-908.
Weaver, F.M., Follett, K., Stern, M., Hur, K., Harris, C., Marks, W.J. Jr, et al. (2009) Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients With Advanced Parkinson Disease: A Randomized Controlled Trial. JAMA, 301(1): 63-73.
Bronstein, J.M., Tagliati, M., Alterman, R.L., Lozano, A.M., Volkmann, J., Stefani, A., et al. (2011) Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Archives of Neurology, 68(2): 165-171.
Okun, M.S. (2012) Deep-Brain Stimulation for Parkinson's Disease. New England Journal of Medicine, 367(16): 1529-1538.
Schuepbach, W.M.M., Rau, J., Knudsen, K., Volkmann, J., Krack, P., Timmermann, L., et al. (2013) Neurostimulation for Parkinson's Disease with Early Motor Complications. New England Journal of Medicine, 368(7): 610-622.
Follett, K.A., Weaver, F.M., Stern, M., Hur, K., Harris, C.L., Luo, P., et al. (2010) Pallidal versus Subthalamic Deep-Brain Stimulation for Parkinson's Disease. New England Journal of Medicine, 362(22): 2077-2091.
Weaver, F.M., Follett, K.A., Stern, M., Luo, P., Harris, C.L., Hur, K., et al. (2012) Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes. Neurology, 79(1): 55-65.
Odekerken, V.J.J., van Laar, T., Staal, M.J., Mosch, A., Hoffmann, C.F.E., Nijssen, P.C.G., et al. (2013) Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial. Lancet Neurology, 12(1): 37-44.
Moro, E., Lozano, A.M., Pollak, P., Agid, Y., Rehncrona, S., Volkmann, J., et al. (2010) Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease. Movement Disorders, 25(5): 578-586.
Mansouri, A., Taslimi, S., Badhiwala, J.H., Witiw, C.D., Nassiri, F., Odekerken, V.J.J., et al. (2018) Deep brain stimulation for Parkinson's disease: meta-analysis of results of randomized trials at varying lengths of follow-up. Journal of Neurosurgery, 128(4): 1199-1213.
Lachenmayer, M.L., Murset, M., Antih, N., Debove, I., Muellner, J., Bompart, M., et al. (2021) Subthalamic and pallidal deep brain stimulation for Parkinson's disease-meta-analysis of outcomes. npj Parkinson's Disease, 7: 77.
Tomlinson, C.L., Stowe, R., Patel, S., Rick, C., Gray, R., Clarke, C.E. (2010) Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Movement Disorders, 25(15): 2649-2653.
Starr, P.A., Shivacharan, R.S., Goldberg, E., Troster, A.I., House, P.A., Giroux, M.L., et al. (2025) Five-Year Outcomes from Deep Brain Stimulation of the Subthalamic Nucleus for Parkinson Disease. JAMA Neurology, 82(11): 1181-1190.
Krack, P., Batir, A., Van Blercom, N., Chabardes, S., Fraix, V., Ardouin, C., et al. (2003) Five-Year Follow-up of Bilateral Stimulation of the Subthalamic Nucleus in Advanced Parkinson's Disease. New England Journal of Medicine, 349(20): 1925-1934.
Fasano, A., Romito, L.M., Daniele, A., Piano, C., Zinno, M., Bentivoglio, A.R., Albanese, A. (2010) Motor and cognitive outcome in patients with Parkinson's disease 8 years after subthalamic implants. Brain, 133(9): 2664-2676.
Castrioto, A., Lozano, A.M., Poon, Y.Y., Lang, A.E., Fallis, M., Moro, E. (2011) Ten-year outcome of subthalamic stimulation in Parkinson disease: a blinded evaluation. Archives of Neurology, 68(12): 1550-1556.
Zibetti, M., Merola, A., Rizzi, L., Ricchi, V., Angrisano, S., Azzaro, C., et al. (2011) Beyond nine years of continuous subthalamic nucleus deep brain stimulation in Parkinson's disease. Movement Disorders, 26(13): 2327-2334.
Bove, F., Mulas, D., Cavallieri, F., Castrioto, A., Chabardes, S., Meoni, S., et al. (2021) Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease. Neurology, 97(3): e254-e262.
Castrioto, A., Debu, B., Cousin, E., Fraix, V., Lhommee, E., Krack, P., et al. (2022) Long-term independence and quality of life after subthalamic stimulation in Parkinson disease. European Journal of Neurology, 29(9): 2645-2653.
Kleiner-Fisman, G., Herzog, J., Fisman, D.N., Tamma, F., Lyons, K.E., Pahwa, R., Lang, A.E., Deuschl, G. (2006) Subthalamic nucleus deep brain stimulation: Summary and meta-analysis of outcomes. Movement Disorders, 21(Suppl 14): S290-S304.
Rasiah, N.P., Maheshwary, R., Kwon, C.S., Bloomstein, J.D., Girgis, F. (2023) Complications of Deep Brain Stimulation for Parkinson Disease and Relationship between Micro-electrode tracks and hemorrhage: Systematic Review and Meta-Analysis. World Neurosurgery, 171: e8-e23.
Xu, Y., Yang, B., Zhou, C., Gu, M., Long, J., Wang, F., et al. (2021) Suicide and suicide attempts after subthalamic nucleus stimulation in Parkinson's disease: a systematic review and meta-analysis. Neurological Sciences, 42(1): 267-274.
Cavallieri, F., Fraix, V., Bove, F., Mulas, D., Tondelli, M., Castrioto, A., et al. (2021) Predictors of Long-Term Outcome of Subthalamic Stimulation in Parkinson Disease. Annals of Neurology, 89(3): 587-597.
Williams, A., Gill, S., Varma, T., Jenkinson, C., Quinn, N., Mitchell, R., et al. (2010) Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial. Lancet Neurology, 9(6): 581-591.
Rodriguez-Oroz, M.C., Moro, E., Krack, P. (2012) Long-term outcomes of surgical therapies for Parkinson's disease. Movement Disorders, 27(14): 1718-1728.
