Author response: Deep brain stimulation in early-stage Parkinson disease: Five-year outcomes
DavidCharles, Professor of Neurology, Vanderbilt University Medical Center (Nashville, TN)
Mallory L.Hacker, Assistant Professor of Neurology, Vanderbilt University Medical Center (Nashville, TN)
Thomas L.Davis, Professor of Neurology, Vanderbilt University Medical Center (Nashville, TN)
Peter E.Konrad, Professor of Neurosurgery, Vanderbilt University Medical Center (Nashville, TN)
Submitted August 06, 2020
We appreciate the interest in our research of deep brain stimulation in early-stage Parkinson’s disease (PD).1 Bradykinesia and tremor are both troubling cardinal motor features of Parkinson disease. There was no significant difference in bradykinesia between the groups throughout the trial. On the other hand, rest tremor was markedly and significantly reduced for subjects receiving early deep brain stimulation, which is notable because tremor is often very distressing for early-stage PD patients.2 Gun-Marie et al. found that “The common view in the medical community that tremor is a less problematic symptom does not fit with our patients’ depiction of the impact of tremor….”3 That said, we do not advocate for a change in clinical practice based on Class II evidence from a single study. Most importantly, there are currently no therapies proven to slow the progression of any feature of PD, and as researchers, we are compelled to continue this line of investigation. The results of this study are encouraging, and we look forward to leading the FDA-approved [IDEG050016] phase III, multicenter, clinical trial of bilateral subthalamic nucleus deep brain stimulation implanted during very early-stage Parkinson’s disease.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Hacker ML, Turchan M, Heusinkveld LE, et al. Deep Brain Stimulation in Early-Stage Parkinson’s Disease: Five Year Outcomes. Neurology 2020 Epub Jun 29.
Heusinkveld LE, Hacker ML, Turchan M, et al. Impact of Tremor on Patients With Early Stage Parkinson's Disease. Front Neurol 2018;9:628.
Gun-Marie H, Limousin P, Hamberg K. "DBS means everything - for some time". Patients' Perspectives on Daily Life with Deep Brain Stimulation for Parkinson's Disease. J Parkinsons Dis 2016;6:335–347.
We appreciate the interest in our research of deep brain stimulation in early-stage Parkinson’s disease (PD).1 Bradykinesia and tremor are both troubling cardinal motor features of Parkinson disease. There was no significant difference in bradykinesia between the groups throughout the trial. On the other hand, rest tremor was markedly and significantly reduced for subjects receiving early deep brain stimulation, which is notable because tremor is often very distressing for early-stage PD patients.2 Gun-Marie et al. found that “The common view in the medical community that tremor is a less problematic symptom does not fit with our patients’ depiction of the impact of tremor….”3 That said, we do not advocate for a change in clinical practice based on Class II evidence from a single study. Most importantly, there are currently no therapies proven to slow the progression of any feature of PD, and as researchers, we are compelled to continue this line of investigation. The results of this study are encouraging, and we look forward to leading the FDA-approved [IDEG050016] phase III, multicenter, clinical trial of bilateral subthalamic nucleus deep brain stimulation implanted during very early-stage Parkinson’s disease.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References