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Abstract
Objectives: Our objective was to compare long-term outcomes of deep brain stimulation (DBS) of the globus pallidus interna (GPi) and subthalamic nucleus (STN) for patients with Parkinson disease (PD) in a multicenter randomized controlled trial.
Methods: Patients randomly assigned to GPi (n = 89) or STN DBS (n = 70) were followed for 36 months. The primary outcome was motor function on stimulation/off medication using the Unified Parkinson's Disease Rating Scale motor subscale. Secondary outcomes included quality of life and neurocognitive function.
Results: Motor function improved between baseline and 36 months for GPi (41.1 to 27.1; 95% confidence interval [CI] −16.4 to −10.8; p < 0.001) and STN (42.5 to 29.7; 95% CI −15.8 to −9.4; p < 0.001); improvements were similar between targets and stable over time (p = 0.59). Health-related quality of life improved at 6 months on all subscales (all p values significant), but improvement diminished over time. Mattis Dementia Rating Scale scores declined faster for STN than GPi patients (p = 0.01); other neurocognitive measures showed gradual decline overall.
Conclusions: The beneficial effect of DBS on motor function was stable and comparable by target over 36 months. Slight declines in quality of life following initial gains and gradual decline in neurocognitive function likely reflect underlying disease progression and highlight the importance of nonmotor symptoms in determining quality of life.
Classification of Evidence: This study provides Class III evidence that improvement of motor symptoms of PD by DBS remains stable over 3 years and does not differ by surgical target. Neurology® 2012;79:55–65
GLOSSARY
- BDI-II=
- Beck Depression Inventory II;
- CI=
- confidence interval;
- DBS=
- deep brain stimulation;
- GPi=
- globus pallidus interna;
- PD=
- Parkinson disease;
- PDQ-39=
- PD Questionnaire-39;
- RCT=
- randomized controlled trial;
- STN=
- subthalamic nucleus;
- UPDRS III=
- Unified Parkinson's Disease Rating Scale motor subscale;
- VA=
- Veterans Affairs
Footnotes
Study funding: Medtronic Neurological, Inc. provided financial support. The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, provided financial support and contributed to the study design. NINDS provided financial support and contributed to the design of the study.
Editorial, page 19
Supplemental data at www.neurology.org.
Coinvestigators and Contributors are listed on the Neurology® Web site at www.neurology.org.
The full protocol is available from the Department of Veterans Affairs, Cooperative Studies Program Office within the Office of Research & Development, Washington, DC, CSP@va.gov or 202-461-1700.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the National Institute of Neurological Disorders and Stroke.
- Received June 9, 2011.
- Accepted November 17, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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