Magazine article Clinical Psychiatry News

Brain Stimulation Eases Parkinson's Symptoms: Patients on Implants and Medication Regimen Saw Improvements in Quality of Life, Motor Function

Magazine article Clinical Psychiatry News

Brain Stimulation Eases Parkinson's Symptoms: Patients on Implants and Medication Regimen Saw Improvements in Quality of Life, Motor Function

Article excerpt

Patients with Parkinson's disease who received continuous electrical stimulation to the subthalamic nucleus experienced significantly greater improvements in various measures of quality of life and motor function after 6 months than did patients who received medication alone, Dr. Gunther Deuschl and colleagues reported.

Results of a new randomized controlled trial from the German Parkinson Study Group of a nonblinded, intention-to-treat population of 78 patient pairs (156 patients) were reported by Dr. Deuschl of Christian Albrechts University in Kiel, Germany, and his colleagues. Patients were recruited from centers in Germany and Austria. One patient in each pair continued to receive an individualized medication regimen alone, while the other received pulsed electrostimulation to the subthalamic nucleus via a surgically implanted device in addition to the medication regimen; stimulation was ongoing and adjusted for each patient (N. Engl. J. Med. 2006;355:896-908).

Primary outcomes were changes in quality of life, as reflected in scores on the Parkinson's Disease Questionnaire (PDQ-39) summary index, and changes in symptom severity after medication withdrawal, as measured by the Unified Parkinson's Disease Rating Scale, Part III (UPDRS-III), the investigators reported.

In 50 of the 78 pairs, the patient who had received neurostimulation showed greater improvements in PDQ-39 summary score than the patient treated with medication alone. The mean PDQ-39 summary score went from 41.8 at baseline in the neurostimulation group to 31.8 at 6 months--an improvement of 24%. In the medication-only group, the mean score was 39.6 at baseline and 40.2 after 6 months.

Motor function (level of symptom severity) in each patient was assessed via the UPDRS-III after a 12-hour withdrawal of antiparkinsonian medications at baseline and at 6 months. In 55 pairs, the patient treated with neurostimulation had a better UPDRS-III score than the nonstimulated patient without medication, reported Dr. Deuschl and colleagues. The neurostimulation group's mean score was 48.0 without medication at baseline, improving to 28.3 at 6 months. For the nonstimulation group, the mean score barely changed, going from 46. …

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