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Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.

Abstract：

BACKGROUND:The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. METHODS:A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. RESULTS:DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p < 0.003), with no significant change in the DBS + ODT group. CONCLUSIONS:DBS + ODT in early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD.

journal_name

Parkinsonism Relat Disord

journal_title

Parkinsonism & related disorders

authors

Hacker ML,Tonascia J,Turchan M,Currie A,Heusinkveld L,Konrad PE,Davis TL,Neimat JS,Phibbs FT,Hedera P,Wang L,Shi Y,Shade DM,Sternberg AL,Drye LT,Charles D

doi

10.1016/j.parkreldis.2015.08.008

subject

Has Abstract

pub_date

2015-10-01 00:00:00

pages

1177-83

issue

eissn

1353-8020

issn

1873-5126

pii

S1353-8020(15)00340-5

journal_volume

pub_type

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Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.