This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Objectives: Our 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.
Methods: Patients 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.
Results: Motor 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.
Conclusions: The 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 Evidence: This 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
GLOSSARY
- BDI-II=
- Beck Depression Inventory II;
- CI=
- confidence interval;
- DBS=
- deep brain stimulation;
- GPi=
- globus pallidus interna;
- PD=
- Parkinson disease;
- PDQ-39=
- PD Questionnaire-39;
- RCT=
- randomized controlled trial;
- STN=
- subthalamic nucleus;
- UPDRS III=
- Unified Parkinson's Disease Rating Scale motor subscale;
- VA=
- Veterans Affairs
Footnotes
Study funding: Medtronic Neurological, Inc. provided financial support. The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, provided financial support and contributed to the study design. NINDS provided financial support and contributed to the design of the study.
Editorial, page 19
Supplemental data at www.neurology.org.
Coinvestigators and Contributors are listed on the Neurology® Web site at www.neurology.org.
The full protocol is available from the Department of Veterans Affairs, Cooperative Studies Program Office within the Office of Research & Development, Washington, DC, CSP@va.gov or 202-461-1700.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the National Institute of Neurological Disorders and Stroke.
- Received June 9, 2011.
- Accepted November 17, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
- Randomized trial of deep brain stimulation for Parkinson disease: Thirty-six-month outcomes
- Reply to Montgomery
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Topics Discussed
Alert Me
Recommended articles
Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation
Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease
A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD
Subthalamic nucleus deep brain stimulation in primary cervical dystonia