Deep-brain stimulation offers QOL benefits for people with advanced Parkinson's Disease

Researchers have shown deep-brain stimulation offers a greater improvement in quality of life (QOL) than 'best care' medical management in patients with advanced Parkinson's Disease and severe motor complications.Motor complications are a common problem encountered when treating patients' symptoms of Parkinson's Disease. Deep-brain stimulation - the continuous electrical stimulation to the subthalamic nucleus through a surgically implanted devise - has been shown to improve motor symptoms. Deuschl et al. performed an unblinded, controlled, randomised-pairs trial comparing neurostimulation with the best medical management over a 6-month period.A total of 156 patients aged less than 75 years and with advanced idiopathic Parkinson's Disease were included into the study. All had severe motor symptoms. The primary outcomes were the changes from baseline to 6 months in QOL as assessed by the Parkinson's Disease Questionnaire (PDQ-39), and the severity of symptoms without medication, which was based on the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III). For every pair of patients enrolled into the study, one was randomly assigned to neurostimulation within 6 weeks of enrolment and the other to best medical treatment.The results of a pair-wise comparison revealed that compared with medication alone, the patient randomised to the neurostimulation group showed greater improvements in QOL (PDQ-39) from baseline to 6 months in 50 of 78 pairs (p=0.02). In 55 pairs, the patient treated with neurostimulation had greater improvement in the score on the UPDRS-III administered when the patients were not taking medication (pThe authors noted that "patients who received neurostimulation had longer periods and better quality of mobility with less dyskinesia." "These changes in motor functioning led to improvement in measurements of activities of daily living, emotional well-being, stigma, and bodily discomfort," they stated.However, they did note that the potential benefits of neurostimulation needed to be carefully weighed up against the risk of surgery-related complications."This trial demonstrated the superior efficacy of neurostimulation over best medical management in patients with advanced Parkinson's Disease and levodopa-related motor complications," they concluded.Reference...