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Randomized trial of deep brain stimulation for Parkinson disease

2012; Lippincott Williams & Wilkins; Volume: 79; Issue: 1 Linguagem: Inglês

10.1212/wnl.0b013e31825dcdc1

1526-632X

Frances M. Weaver, Kenneth A. Follett, Matthew Stern, Ping Luo, Crystal L. Harris, Kwan Hur, William J. Marks, Johannes Rothlind, Oren Sagher, Claudia S. Moy, Rajesh Pahwa, Kim J. Burchiel, Penelope Hogarth, Eugene C. Lai, John E. Duda, Kathryn L. Holloway, Ali Samii, Stacy Horn, Jeff M. Bronstein, Gatana Stoner, Philip A. Starr, Richard K. Simpson, Gordon H. Baltuch, Antônio De Salles, Grant D. Huang, Domenic J. Reda, Dolores Ippolito, Tammy Barnett, Ken Bukowski, Kimberly Carlson, B. Christine, Rosemarie DeNicolo, Joyce Jimenez, Jan Motyka, Unnati Patel, Theresa Simon, Bharat Thakkar, Robert F. Woolson, Carol L. Fye, William Gagne, Paul A. Sheehy, Timothy J. O’Leary, Farah Atassi, Cecilia Bukola Bello, Lisette Bunting‐Perry, Tina Conn, Alice Cugley, Nanette Eubank, Linda Fincher, Romay Franks, T. B. Harris, Mariann Haselman, Susan Heath, Miriam Hirsch, Virginia Janovsky, Elaine Lanier, Mary Lloyd, Susan Loehner, Susan O’Connor, Ligaya Ordonez, Heather Maccarone, Kelli Massey-Makhoul, Mary Matthews, Elizabeth Meyn, Keiko Mimura, W.G. Morrow, Tammy Searles, Jamye Valotta, U. S. Vasthare, Monica Volz, Constance Ward, Rebecca Warker, Heidi Watson, Pamela Willson, Mark S. Baron, Matthew Brodsky, Vincent P. Calabrese, Gordon Campbell, Amy Colcher, Emad Farag, Eva Henry, Jyhgong Gabriel Hou, Gail A. Kang, Galit Kleiner‐Fisman, Jeff Kraakevik, John G. Nutt, Jill L. Ostrem, Aliya Sarwar, Indu Subramanian, Zeba Vanek, William Carne, Tom Erikson, Jeffrey S. Kreutzer, Mario F. Mendez, Paul Moberg, J. L. Ragland, Ronald T. Seel, Elizabeth Soety, Daniel Storzbach, Alexander I. Tröster, Michele K. York, Jurg L. Jaggi, Kevin T. Stroupe, William C. Koller,

Autism Spectrum Disorder Research

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 Parkinson9s 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