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Abstract
Objective: To compare motor symptoms, cognition, mood, and behavior 3 years after deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and subthalamic nucleus (STN) in advanced Parkinson disease (PD).
Methods: Patients with PD eligible for DBS were randomized to bilateral GPi DBS and bilateral STN DBS (1:1). The primary outcome measures were (1) improvement in motor symptoms in off-drug phase measured with the Unified Parkinson Disease Rating Scale (UPDRS) and (2) a composite score for cognitive, mood, and behavioral effects, and inability to complete follow-up at 36 months after surgery.
Results: Of the 128 patients enrolled, 90 were able to complete the 3-year follow-up. We found significantly more improvement of motor symptoms after STN DBS (median [interquartile range (IQR)] at 3 years, GPi 33 [23–41], STN 28 [20–36], p = 0.04). No between-group differences were observed on the composite score (GPi 83%, STN 86%). Secondary outcomes showed larger improvement in off-drug functioning in the AMC Linear Disability Scale score after STN DBS (mean ± SD, GPi 65.2 ± 20.1, STN 72.6 ± 18.0, p = 0.05). Medication was reduced more after STN DBS (median levodopa equivalent dose [IQR] at 3 years, GPi 1,060 [657–1,860], STN 605 [411–875], p < 0.001). No differences in adverse effects were recorded, apart from more reoperations to a different target after GPi DBS (GPi n = 8, STN n = 1).
Conclusions: Off-drug phase motor symptoms and functioning improve more after STN DBS than after GPi DBS. No between-group differences were observed on a composite score for cognition, mood, and behavior, and the inability to participate in follow-up.
Classification of evidence: This study provides Class II evidence that STN DBS provides more off-phase motor improvement than GPi DBS, but with a similar risk for cognitive, mood, and behavioral complications.
GLOSSARY
- ADL=
- activities of daily living;
- ALDS=
- Academic Medical Center Linear Disability Score;
- CDRS=
- Clinical Dyskinesia Rating Scale;
- DBS=
- deep brain stimulation;
- GPi=
- globus pallidus pars interna;
- IQR=
- interquartile range;
- MDRS=
- Mattis Dementia Rating scale;
- ME=
- Motor Examination;
- NSTAPS=
- Netherlands Subthalamic and Pallidal Stimulation;
- PD=
- Parkinson disease;
- PDQL=
- Parkinson's Disease Quality of Life Questionnaire;
- PDSS=
- Parkinson's Disease Sleep Scale;
- S&E=
- Schwab & England score;
- STN=
- subthalamic nucleus;
- UPDRS=
- Unified Parkinson's Disease Rating Scale
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
Coinvestigators are listed on the Neurology® Web site at Neurology.org.
Supplemental data at Neurology.org
- Received July 4, 2015.
- Accepted in final form October 29, 2015.
- © 2016 American Academy of Neurology
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