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Deep Brain Stimulation Effective in Early Parkinsonís Disease
- Feb 21 2013
A new study published online February 13 in The New England Journal of Medicine suggests that suggests that deep brain stimulation (DBS) for Parkinson’s disease (PD) may be helpful for treating people in earlier stages of PD.
DBS is surgical treatment that provides a tiny electric current to structures of the brain in order to block motor symptoms of PD. The technique involves the surgical insertion of tiny electrodes deep into the brain and the implantation of an impulse generator (similar to a pacemaker) under the collarbone to provide an electrical impulse to the brain.
DBS has traditionally been reserved for people who have lived with PD for 10 to 15 years, who experience severe symptom and medication fluctuations, and disabling dyskinesias (involuntary twisting and writhing movements).
Researchers led by Günther Deuschl, M.D., Ph.D., at University Hospital Schleswig-Holstein, in Kiel, Germany, wondered whether DBS could be effective in people during earlier stages of PD, when they were just starting to experience motor complications. Building upon their earlier pilot study, researchers divided 251 people with PD and early motor complications into two groups: those who would undergo DBS plus standard medical therapy (including levodopa) versus those who would receive medical therapy alone. The people in this study were relatively young: they developed PD when they were 45 years old and underwent DBS at age 52 years, after living with PD for seven years.
- Over the two year period, quality of life improved by 26 percent in the group receiving DBS plus medical therapy. In contrast, quality of life for those receiving medical therapy alone was relatively unchanged.
- The DBS group showed less motor disability, a greater ability to perform activities of daily living, fewer side effects caused by long-term levodopa use, and more time with good mobility and no dyskinesia than the group receiving medical therapy alone.
- In terms of serious health problems, suicide occurred with two participants in the DBS group one in the medical therapy group. Other effects such as worsened mobility, depression, or hallucinations, occurred in 54.8 percent of people in the DBS group and in 44.1 percent of those in the medical therapy group.
- Serious health problems related to surgical implantation of the DBS device, such as poor wound healing, a brain abscess, or dislocation of the device, occurred in 17.7 percent of the participants in the DBS group.
- The DBS group required a 39 percent lower dose of PD dopaminergic medication after two years than they did at the beginning of the study. In contrast, the people in the medical therapy group had to increase their medication dose by an average of 21 percent to adequately control their symptoms.
What Does It Mean?
DBS is an established therapy for people with advanced PD. Because DBS has not been proven to slow PD or confer any long-term benefit when performed early, there has been no urgency in the US to offer the treatment to individuals with less advanced PD. This study provides new evidence that offering DBS earlier may improve quality of life for some people with PD and may spare those individuals dependency on complicated PD drug schedules.
The participants in this study differed from those in previous studies in that they were younger, had PD for a shorter period of time, and still responded fairly well to medication. At the end of the two year study, the group who received DBS recorded the highest quality of life scores, as well as the best motor symptom scores. An added benefit of DBS was that it allowed people in this group to reduce their dose of levodopa, lowering the risk of side effects. In contrast, people in the medical therapy group had to increase their dose of levodopa to adequately control their symptoms.
For American readers, this study is convincing and important. It also raises questions since DBS is not typically performed in the US for those people for whom medication adjustment is easy and effective remedy. In fact, the invasive nature of DBS has been held up as a reason to postpone DBS surgery for as long as possible.
DBS remains elective surgery, and the decision about whether to undergo DBS is always very serious and very personal. Further research is needed to clarify the long-term impact of performing DBS earlier in the progression of PD.
Lastly, it is important to note that unlike most clinical trials, involving medication, surgical trials are more difficult “blind.” For the individuals who has DBS, the knowledge that they received the treatment may have buoyed their optimism regarding the result.
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Source Date: Feb 21 2013