Vincent J J Odekerken1, Judith A Boel2, Ben A Schmand2, Rob J de Haan2, M Figee2, Pepijn van den Munckhof2, P Richard Schuurman2, Rob M A de Bie2. 1. From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands. v.j.odekerken@amc.uva.nl. 2. From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
Abstract
OBJECTIVE: To compare motor symptoms, cognition, mood, and behavior 3 years after deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and subthalamic nucleus (STN) in advanced Parkinson disease (PD). METHODS:Patients with PD eligible for DBS were randomized to bilateral GPi DBS and bilateral STN DBS (1:1). The primary outcome measures were (1) improvement in motor symptoms in off-drug phase measured with the Unified Parkinson Disease Rating Scale (UPDRS) and (2) a composite score for cognitive, mood, and behavioral effects, and inability to complete follow-up at 36 months after surgery. RESULTS: Of the 128 patients enrolled, 90 were able to complete the 3-year follow-up. We found significantly more improvement of motor symptoms after STN DBS (median [interquartile range (IQR)] at 3 years, GPi 33 [23-41], STN 28 [20-36], p = 0.04). No between-group differences were observed on the composite score (GPi 83%, STN 86%). Secondary outcomes showed larger improvement in off-drug functioning in the AMC Linear Disability Scale score after STN DBS (mean ± SD, GPi 65.2 ± 20.1, STN 72.6 ± 18.0, p = 0.05). Medication was reduced more after STN DBS (median levodopa equivalent dose [IQR] at 3 years, GPi 1,060 [657-1,860], STN 605 [411-875], p < 0.001). No differences in adverse effects were recorded, apart from more reoperations to a different target after GPi DBS (GPi n = 8, STN n = 1). CONCLUSIONS: Off-drug phase motor symptoms and functioning improve more after STN DBS than after GPi DBS. No between-group differences were observed on a composite score for cognition, mood, and behavior, and the inability to participate in follow-up. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that STN DBS provides more off-phase motor improvement than GPi DBS, but with a similar risk for cognitive, mood, and behavioral complications.
RCT Entities:
OBJECTIVE: To compare motor symptoms, cognition, mood, and behavior 3 years after deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and subthalamic nucleus (STN) in advanced Parkinson disease (PD). METHODS:Patients with PD eligible for DBS were randomized to bilateral GPi DBS and bilateral STN DBS (1:1). The primary outcome measures were (1) improvement in motor symptoms in off-drug phase measured with the Unified Parkinson Disease Rating Scale (UPDRS) and (2) a composite score for cognitive, mood, and behavioral effects, and inability to complete follow-up at 36 months after surgery. RESULTS: Of the 128 patients enrolled, 90 were able to complete the 3-year follow-up. We found significantly more improvement of motor symptoms after STN DBS (median [interquartile range (IQR)] at 3 years, GPi 33 [23-41], STN 28 [20-36], p = 0.04). No between-group differences were observed on the composite score (GPi 83%, STN 86%). Secondary outcomes showed larger improvement in off-drug functioning in the AMC Linear Disability Scale score after STN DBS (mean ± SD, GPi 65.2 ± 20.1, STN 72.6 ± 18.0, p = 0.05). Medication was reduced more after STN DBS (median levodopa equivalent dose [IQR] at 3 years, GPi 1,060 [657-1,860], STN 605 [411-875], p < 0.001). No differences in adverse effects were recorded, apart from more reoperations to a different target after GPi DBS (GPi n = 8, STN n = 1). CONCLUSIONS: Off-drug phase motor symptoms and functioning improve more after STN DBS than after GPi DBS. No between-group differences were observed on a composite score for cognition, mood, and behavior, and the inability to participate in follow-up. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that STN DBS provides more off-phase motor improvement than GPi DBS, but with a similar risk for cognitive, mood, and behavioral complications.
Authors: Stephanie Cernera; Robert S Eisinger; Joshua K Wong; Kwo Wei David Ho; Janine Lobo Lopes; Kevin To; Samuel Carbunaru; Adolfo Ramirez-Zamora; Leonardo Almeida; Kelly D Foote; Michael S Okun; Aysegul Gunduz Journal: NPJ Parkinsons Dis Date: 2020-07-06
Authors: Joshua K Wong; James H Cauraugh; Kwo Wei David Ho; Matthew Broderick; Adolfo Ramirez-Zamora; Leonardo Almeida; Aparna Wagle Shukla; Christina A Wilson; Rob Ma de Bie; Frances M Weaver; Nyeonju Kang; Michael S Okun Journal: Parkinsonism Relat Disord Date: 2018-08-28 Impact factor: 4.891
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