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Parkinson Disease: Neurostimulation vs. Medical Therapy
Deep brain stimulation produces greater improvements than medical therapy in patients with Parkinson disease, but at the risk of serious adverse events, according to a JAMA study.
Researchers randomized some 250 patients with moderate-to-severe disease to either state-of-the-art medical therapy or bilateral deep brain stimulation via implanted electrodes. The primary outcome measure was the patient's self-reported time in the "on" state (defined as periods of good symptom control with unimpeded motor function).
At 6 months, patients on deep stimulation reported an average increase of 4.6 hours of "on" time per day over baseline, compared with 0 hours in the medically treated group. (Blinded raters independently confirmed an improvement in motor scores.)
An editorialist says the study "convincingly confirmed" the efficacy of deep brain stimulation found earlier, but warns about the procedure's complications — for instance, a 10% rate of device-related problems at 6 months.
LINK(S):
JAMA article (Free abstract; full text requires subscription)
JAMA editorial (Subscription required)
NEJM study on deep brain stimulation from 2006 (Free)
Associated Press story (Free)
Published in Physician's First Watch January 7, 2009
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