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Brain stimulation trumps drugs for parkinson's.

CHICAGO -- Preliminary data suggest that deep brain stimulation may be superior to medical therapy in Parkinson's disease, and that stimulating specific targets may lead to different outcomes.

Complete data on 230 of 255 patients with idiopathic Parkinson's disease showed that motor functioning at 6 months, based on blinded ratings, improved 36% over baseline with deep brain stimulation (DBS), but only 5% with the best medical therapy (BMT), Frances M. Weaver, Ph.D., co-principal investigator, reported in a poster at the 12th International Congress of Parkinson's Disease and Movement Disorders.

Time without troublesome dyskinesia increased by 5.1 hours with DBS, compared with no change with BMT. The 111 DBS patients experienced significant improvement in all aspects of the Parkinson's Disease Questionnaire-39, except for social support, compared with the 119 BMT patients who had little change.

However, these gains must be weighed against the greater risk of serious adverse events following DBS, Dr. Weaver reported on behalf of the Veterans Affairs/National Institute of Neurological Disorders and Stroke (VA/NINDS-01) Study Group. At least one serious adverse event was experienced by 40% of DBS patients, compared with only 11% of BMT patients.

The trial included patients aged 22 years or older (mean age 63 years) with Hoehn and Yahr stage 2 or greater idiopathic Parkinson's disease responsive to L-dopa, but with persistent motor complications. BMT patients received optimized medical therapy, and DBS patients were further randomized to bilateral stimulation of the subthalamic nucleus (STN) or globus pallidus interna (GPi). The BMT arm was discontinued early as there was sufficient power to compare the primary outcome with the first 255 patients. Most BMT patients proceeded to surgical treatment, Dr. Weaver, of Hines (Ill.) Veterans Affairs Hospital, said in an interview. Results of the DBS target (STN vs. GPi) portion of the trial are expected in 2009.

In a second study, a prospective, randomized trial called COMPARE (Comparison of Best Medical Therapy and Deep Brain Stimulation of Subthalamic Nucleus and Globus Pallidus for the Treatment of Parkinson's Disease), 6-month data on 45 of 52 patients (mean age 61 years) showed no significant difference between 22 STN and 23 GPi patients in seven of the eight subscales of the visual analog mood scale, said Dr. Michael S. Okun, who has received speaking and consulting fees from the National Parkinson's Foundation and Medtronic Inc. The trial was funded by the National Institute of Neurological Disorders and Stroke and the University of Florida.


Chicago Bureau

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Title Annotation:Clinical Rounds
Author:Wendling, Patrice
Publication:Family Practice News
Date:Oct 1, 2008
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