Comparison of Pallidal and Subthalamic Nucleus Deep Brain Stimulation for Advanced Parkinson's Disease: Results of a Randomized, Blinded Pilot Study

Comparison of Pallidal and Subthalamic Nucleus Deep Brain Stimulation for Advanced Parkinson's... AbstractOBJECTIVE:Deep brain stimulation (DBS) of the globus pallidus internus (GPi) and subthalamic nucleus (STN) has been reported to be effective in alleviating the symptoms of advanced Parkinson's disease (PD). Although recent studies suggest that STN stimulation may be superior to GPi stimulation, a randomized, blinded comparison has not been reported. The present study was designed to provide a preliminary comparison of the safety and efficacy of DBS at either site.METHODS:Ten patients with idiopathic PD, L-dopa-induced dyskinesia, and response fluctuations were randomized to implantation of bilateral GPi or STN stimulators. Neurological condition was assessed preoperatively with patients on and offL-dopa and on DBS at 10 days and 3, 6, and 12 months after implantation. Patients and evaluating clinicians were blinded to stimulation site throughout the study period. Complete follow-up data were analyzed for four GPi patients and five STN patients.RESULTS:When off-L-dopa, both GPi and STN groups demonstrated a similar response, with approximately 40% improvement in Unified PD Rating Scale motor scores after 12 months of DBS. Rigidity, tremor, and bradykinesia improved in both groups. In combination with L-dopa, Unified PD Rating Scale motor scores were more improved by GPi stimulation than by STN stimulation. On-L-dopa axial symptoms were clinically improved in the GPi but not the STN group. L-Dopa-induced dyskinesia was reduced by DBS at either site, although medication requirement was reduced only in the STN group. There were no serious intraoperative complications among patients in either group.CONCLUSION:Pallidal and STN stimulation appears to be safe and efficacious for the management of advanced PD. A larger study is needed to investigate further the differences in symptom response and the interaction of L-dopa with stimulation at either site. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Comparison of Pallidal and Subthalamic Nucleus Deep Brain Stimulation for Advanced Parkinson's Disease: Results of a Randomized, Blinded Pilot Study

Comparison of Pallidal and Subthalamic Nucleus Deep Brain Stimulation for Advanced Parkinson's Disease: Results of a Randomized, Blinded Pilot Study

Comparison of Pallidal and Subthalamic Nucleus Deep Brain Stimulation for Advanced Parkinson's Disease: Results of a Randomized, Blinded Pilot Study K i m J . B u r c h i e l , M . D . , V a l e r i e C . A n d e r s o n , P h . D . , J a c q u e s F a v r e , M . D . , J o h n P . H a m m e r s t a d , M . D . Departments of Neurological Surgery (KJB, VCA, )F) and Neurology (JPH), Oregon Health Sciences University, Portland, Oregon OBJECTIVE: Deep brain stim ulation (D B S ) of the globus pallidus internus (G Pi) and subthalamic nucleus (STN) has been reported to be effective in alleviating the symptoms of advanced Parkinson's disease (PD ). Although recent studies suggest that STN stimulation may be superior to G Pi stimulation, a randomized, blinded comparison has not been reported. The present study was designed to provide a preliminary comparison of the safety and efficacy of DBS at either site. METHODS: Ten patients w ith idiopathic PD, L-dopa-induced dyskinesia, and response fluctuations were randomized to implantation of bilateral G P i or STN stimulators. Neurological condition was assessed preoperatively with patients on and o ff L-dopa and on D BS at 10 days and 3, 6, and 12 months after implantation. Patients and evaluating clinicians w ere blinded to stimulation site throughout the study period. Complete follow-up data were analyzed for four G P i patients and five STN patients. RESULTS: W hen off-L-dopa, both G P i and STN groups demonstrated a similar response, with approximately 4 0 % improvement in U nified PD Rating Scale motor scores after 12 months of DBS. Rigidity, tremor, and bradykinesia improved in both groups. In com bination with L-dopa, Unified PD Rating Scale motor scores were more improved by GPi stimulation than by STN stimulation. On-L-dopa axial symptoms were clinically improved in the G P i but not the STN group. L-Dopa-induced dyskinesia was reduced by D BS at either site, although medication require­ ment was...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199912000-00024
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:Deep brain stimulation (DBS) of the globus pallidus internus (GPi) and subthalamic nucleus (STN) has been reported to be effective in alleviating the symptoms of advanced Parkinson's disease (PD). Although recent studies suggest that STN stimulation may be superior to GPi stimulation, a randomized, blinded comparison has not been reported. The present study was designed to provide a preliminary comparison of the safety and efficacy of DBS at either site.METHODS:Ten patients with idiopathic PD, L-dopa-induced dyskinesia, and response fluctuations were randomized to implantation of bilateral GPi or STN stimulators. Neurological condition was assessed preoperatively with patients on and offL-dopa and on DBS at 10 days and 3, 6, and 12 months after implantation. Patients and evaluating clinicians were blinded to stimulation site throughout the study period. Complete follow-up data were analyzed for four GPi patients and five STN patients.RESULTS:When off-L-dopa, both GPi and STN groups demonstrated a similar response, with approximately 40% improvement in Unified PD Rating Scale motor scores after 12 months of DBS. Rigidity, tremor, and bradykinesia improved in both groups. In combination with L-dopa, Unified PD Rating Scale motor scores were more improved by GPi stimulation than by STN stimulation. On-L-dopa axial symptoms were clinically improved in the GPi but not the STN group. L-Dopa-induced dyskinesia was reduced by DBS at either site, although medication requirement was reduced only in the STN group. There were no serious intraoperative complications among patients in either group.CONCLUSION:Pallidal and STN stimulation appears to be safe and efficacious for the management of advanced PD. A larger study is needed to investigate further the differences in symptom response and the interaction of L-dopa with stimulation at either site.

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1999

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