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Previous Volume 355:896-908 August 31, 2006 Number 9 Next

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ABSTRACT

Background Neurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson's disease. We compared this treatment plus medication with medical management.

Methods In this randomized-pairs trial, we enrolled 156 patients with advanced Parkinson's disease and severe motor symptoms. The primary end points were the changes from baseline to six months in the quality of life, as assessed by the Parkinson's Disease Questionnaire (PDQ-39), and the severity of symptoms without medication, according to the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III).

Results Pairwise comparisons showed that neurostimulation, as compared with medication alone, caused greater improvements from baseline to six months in the PDQ-39 (50 of 78 pairs, P=0.02) and the UPDRS-III (55 of 78, P<0.001), with mean improvements of 9.5 and 19.6 points, respectively. Neurostimulation resulted in improvements of 24 to 38 percent in the PDQ-39 subscales for mobility, activities of daily living, emotional well-being, stigma, and bodily discomfort. Serious adverse events were more common with neurostimulation than with medication alone (13 percent vs. 4 percent, P<0.04) and included a fatal intracerebral hemorrhage. The overall frequency of adverse events was higher in the medication group (64 percent vs. 50 percent, P=0.08).

Conclusions In this six-month study of patients under 75 years of age with severe motor complications of Parkinson's disease, neurostimulation of the subthalamic nucleus was more effective than medical management alone. (ClinicalTrials.gov number, NCT00196911 [ClinicalTrials.gov] .)

Source Information

From Christian Albrechts University, Kiel (G.D., P.K., J.V., C.D., W.H., J.H., S.K., D.L., H.M.M., M.O.P.); Philipps University, Marburg (C.S.-B., H.S., W.O., A.R.); Ludwig Maximilians University, Munich (K.B., A.D., S.L., U.S.); Homburg University, Homburg (U.D., J.R.M.); Charité Hospital, Humboldt University, Berlin (D.G., A.K., G.-H.S., T.T.); Cologne University, Cologne, (R.H., V.S., J.V.); Heidelberg University, Heidelberg (M.Kloß, M.Krause, V.T.); Dresden University, Dresden (J.K., H.R.); and Heinrich Heine University, Dusseldorf (A.S., L.T., L.W.) — all in Germany; and Innsbruck Medical University, Innsbruck, Austria (W.E., E.W., W.P.).

Address reprint requests to Dr. Deuschl at the Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian Albrechts University, Schittenhelmstrasse 10, 24105 Kiel, Germany, or at g.deuschl{at}neurologie.uni-kiel.de.

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Related Letters:

Deep-Brain Stimulation for Parkinson's Disease
Lieb K., Schlaepfer T. E., Deuschl G., Volkmann J.
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N Engl J Med 2006; 355:2256, Nov 23, 2006. Correspondence

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