1. Randomized trial of deep brain stimulation for Parkinson disease
- Author
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Weaver, Frances M, Follett, Kenneth A, Stern, Matthew, Luo, Ping, Harris, Crystal L, Hur, Kwan, Marks, William J, Rothlind, Johannes, Sagher, Oren, Moy, Claudia, Pahwa, Rajesh, Burchiel, Kim, Hogarth, Penelope, Lai, Eugene C, Duda, John E, Holloway, Kathryn, Samii, Ali, Horn, Stacy, Bronstein, Jeff M, Stoner, Gatana, Starr, Philip A, Simpson, Richard, Baltuch, Gordon, De Salles, Antonio, Huang, Grant D, and Reda, Domenic J
- Subjects
Clinical Trials and Supportive Activities ,Brain Disorders ,Aging ,Assistive Technology ,Neurosciences ,Parkinson's Disease ,Clinical Research ,Bioengineering ,Rehabilitation ,Neurodegenerative ,Neurological ,Aged ,Deep Brain Stimulation ,Female ,Follow-Up Studies ,Humans ,Male ,Middle Aged ,Motor Skills ,Parkinson Disease ,Prospective Studies ,Quality of Life ,Single-Blind Method ,Treatment Outcome ,CSP 468 Study Group ,Clinical Sciences ,Cognitive Sciences ,Neurology & Neurosurgery - Abstract
ObjectivesOur objective was to compare long-term outcomes of deep brain stimulation (DBS) of the globus pallidus interna (GPi) and subthalamic nucleus (STN) for patients with Parkinson disease (PD) in a multicenter randomized controlled trial.MethodsPatients randomly assigned to GPi (n = 89) or STN DBS (n = 70) were followed for 36 months. The primary outcome was motor function on stimulation/off medication using the Unified Parkinson's Disease Rating Scale motor subscale. Secondary outcomes included quality of life and neurocognitive function.ResultsMotor function improved between baseline and 36 months for GPi (41.1 to 27.1; 95% confidence interval [CI] -16.4 to -10.8; p < 0.001) and STN (42.5 to 29.7; 95% CI -15.8 to -9.4; p < 0.001); improvements were similar between targets and stable over time (p = 0.59). Health-related quality of life improved at 6 months on all subscales (all p values significant), but improvement diminished over time. Mattis Dementia Rating Scale scores declined faster for STN than GPi patients (p = 0.01); other neurocognitive measures showed gradual decline overall.ConclusionsThe beneficial effect of DBS on motor function was stable and comparable by target over 36 months. Slight declines in quality of life following initial gains and gradual decline in neurocognitive function likely reflect underlying disease progression and highlight the importance of nonmotor symptoms in determining quality of life.Classification of evidenceThis study provides Class III evidence that improvement of motor symptoms of PD by DBS remains stable over 3 years and does not differ by surgical target. Neurology® 2012;79:55-65.
- Published
- 2012