Deep brain stimulation for advanced Parkinson's disease

Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus has become a common treatment option for patients with advanced Parkinson's disease. Comparison of DBS with best medical treatment, including the most recent semi-invasive treatment options such as continuous infusion of apomorphine or levodopa, is necessary to calculate the risk:benefit ratios of each treatment. In this issue of The Lancet Neurology, Williams and colleagues 1 Williams A Gill S Varma T et al. on behalf of the PD SURG collaborative groupDeep brain stimulation surgery plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol. 2010; (published online April 29.)https://doi.org/10.1016/S1474-4422(10)70093-4 Summary Full Text Full Text PDF Scopus (525) Google Scholar report the results at 1 year from a randomised, multicentre trial on the effects of surgery plus best medical therapy compared with best medical therapy alone in patients with advanced Parkinson's disease. Although, according to the protocol, lesion and stimulation of the subthalamic nucleus and globus pallidus pars interna were allowed in patients allocated to the surgery group, in practice 174 of 178 patients (98%) had DBS of the subthalamic nucleus. The results at 1 year show that DBS of the subthalamic nucleus and best medical therapy improved quality of life more than best medical therapy alone (5·0 point decrease in the Parkinson's disease questionnaire score in the surgery group vs 0·3 point decrease in the medical treatment group). Patients in the surgery group also had greater improvement in the total unified Parkinson's disease rating scale (UPDRS) and in the motor (in both on and off states) and complications of therapy (dyskinesias and off periods) sections. The daily requirement of dopaminergic drugs was 33% lower in the surgery group than in the medical therapy group. There was no difference between the two groups in cognition, as measured by the dementia rating scale-II (DRS-II). However, a more detailed neuropsychological study in a subgroup of patients showed that there was a decline in verbal fluency and vocabulary in the surgery group compared with the medical therapy group. There were more serious adverse events in the surgery group, which were mainly related to surgery. Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trialAt 1 year, surgery and best medical therapy improved patient self-reported quality of life more than best medical therapy alone in patients with advanced Parkinson's disease. These differences are clinically meaningful, but surgery is not without risk and targeting of patients most likely to benefit might be warranted. Full-Text PDF Open Access