Objectives. To determine the efficacy of electrical stimulation of the subthalamic nucleus using different methods to verify target structure in patients with Parkinson’s disease based on assessment of the dynamics of motor symptoms. Materials and methods. A total of 60 patients with PD with chronic bilateral electrical stimulation of the subthalamic nucleus (ES of the STN) were studied. Multichannel microelectrode recording (MER) was performed during neurostimulation electrode implantation surgery in 30 cases. Intraoperative MER was not performed in 30 cases. The control group consisted of 30 patients with PD who received only conservative medication-based treatment. Patient investigations used the Hoehn and Yahr scale, the Tinetti Balance and Mobility Scale (TBMS), the Unifi ed Parkinson’s Disease Rating Scale (UPDRS), the PDQ-39 quality of life self-assessment scale for Parkinson’s disease, and the Schwab and England Activities of Daily Living (ADL) scale. The levodopa equivalent daily dose (LEDD) was determined individually for each patient. Results and conclusions. ES of the STN was found to be effective when used in combination with MER in terms of effects on the severity of the main motor symptoms, motor complications, gait, and measures of quality of life and the activities of daily living. On the background of ES of the STN, patients of both surgical groups attained significant reductions in LEDD with marked improvements in the control of the motor symptoms of PD; significant decreases in the severity of motor fluctuation (50%) and peak dose iatrogenic dyskinesias (51%) were seen. Measures of quality of life and the activities of daily living while off medication improved significantly in both groups of patients receiving ES of the STN independently of the intraoperative target selection technique (75–100%) as compared with the control group.

Objective. To analyze pharmacotherapy on the background of stimulation of the subthalamic nucleus (STN). Materials and methods. A total of 54 patients with implanted STN stimulation systems (Medtronic) were investigated from 2003 to 2012. The severity of motor disorders, daily activity, and complications of pharmacotherapy were evaluated using parts II, III, and IV of the Unified Parkinson’s Disease Rating Scale (UDPRS) before surgery and at one, three, and four years of continuing stimulation. The equivalent daily dose of levodopa was evaluated, along with analysis of pharmacotherapy overall. Results and conclusions. The severity of motor impairments in off periods decreased by 52.3% by one year of observation and remained stable for three years (51.8%), after which there was a small increase in the severity of motor symptoms, though not to the pre-operative level. The severity of motor fluctuations and iatrogenic dyskinesia decreased by 64.9%, 70.7%, and 42.7% at the ends of years 1, 3, and 4, respectively. The levodopa equivalent dose showed the greatest decrease by one year (57.7%), with decreases by 52.4% and 38.2% at three and four years, respectively. During the first year, 16.7% of patients took no levodopa. The levodopa dose decreased by 64.6% at one year and then by 56.7% and 43.7% at three and four years, respectively. Dopaminergic receptor agonist monotherapy was used in 12.9% of patients, the proportion receiving agonists in combined therapy increasing from 24.1% to 35.2% during the post-operative period.

Study aim. To assess the efficacy of electrostimulation of the subthalamic nucleus (ES STN) in patients with Parkinson’s disease (PD) in comparison with drug treatment. Materials and methods. ES STN was performed in 22 patients (mean age 53.2 years, mean duration of illness 9.6 years). The control group consisted of 28 patients with PD who received drug treatment (mean age 54.2 years, mean duration of illness 9.6 years). Patients were assessed in the “off” and “on” medication periods at 3, 6, 9, 12, 24, and 36 months from the start of the study. Assessments were performed using the Unifi ed PD Rating Scale (UPDRS), parts II, III, and IV of the Hoehn and Yahr scale, the Hamilton depression scale, and the Spielberger anxiety scale. All patients of both groups showed dyskinesia and motor fluctuations. Results and conclusions. Improvements in status were seen in surgical patients on the UPDRS (parts II and III), with decreases in dyskinesia and motor fluctuations. After neurosurgical treatment, dopaminergic treatment was decreased by 54.5%. In the control group, the levodopa dose increased by 20.5% by observation month 36.