After previously showing in 2009 that for Parkinson’s “deep brain stimulation was more effective than best medical therapy in improving on time without troubling dyskinesias, motor function, and quality of life at 6 months, but was associated with an increased risk of serious adverse events,” a continuation of that study was published in this week’s New England Journal of Medicine. This study compared the two popular targets for Deep Brain Stimulation, globus pallidus interna (pallidal stimulation) or subthalamic nucleus (subthalamic stimulation). The study used Medtronic’s Kinetra neurostimulator and showed no significant difference in outcome between the two sites.
From the NEJM abstract:
Results Mean changes in the primary outcome did not differ significantly between the two study groups (P=0.50). There was also no significant difference in self-reported function. Patients undergoing subthalamic stimulation required a lower dose of dopaminergic agents than did those undergoing pallidal stimulation (P=0.02). One component of processing speed (visuomotor) declined more after subthalamic stimulation than after pallidal stimulation (P=0.03). The level of depression worsened after subthalamic stimulation and improved after pallidal stimulation (P=0.02). Serious adverse events occurred in 51% of patients undergoing pallidal stimulation and in 56% of those undergoing subthalamic stimulation, with no significant between-group differences at 24 months.
Conclusions Patients with Parkinson’s disease had similar improvement in motor function after either pallidal or subthalamic stimulation. Nonmotor factors may reasonably be included in the selection of surgical target for deep-brain stimulation.
Full NEJM Abstract: Pallidal versus Subthalamic Deep-Brain Stimulation for Parkinson’s Disease…
Statement from Medtronic:New Data in The New England Journal Of Medicine Show Medtronic Deep Brain Stimulation Provides Sustained Motor Function Improvement in Parkinson’s Disease…