Author response: Deep brain stimulation in early-stage Parkinson disease: Five-year outcomes
Mallory L.Hacker, Assistant Professor of Neurology, Vanderbilt University Medical Center (Nashville, TN)
Peter E.Konrad, Professor of Neuroscience & Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University (Morgantown, WV)
Thomas L.Davis, Professor of Neurology, Vanderbilt University Medical Center (Nashville, TN)
DavidCharles, Professor of Neurology, Vanderbilt University Medical Center (Nashville, TN)
Submitted September 05, 2020
We appreciate the interest in our research1 of subthalamic nucleus (STN) deep brain stimulation (DBS) in early-stage Parkinson disease (PD). As noted in our publication, “Participants returned to the Vanderbilt Clinical Research Center (CRC) for annual outpatient study visits at years 3, 4, and 5, undergoing evaluations similar to the day 1 assessments conducted during the initial 2-year trial.” We would like to clarify that off-therapy tremor scores were not collected in follow-up years 3, 4, or 5 due to a lack of funding. We agree that reduced dyskinesia was expected due to the long-standing history of STN DBS being a potent therapy to reduce medications, and therefore dyskinesia, in advanced-stage Parkinson disease. We are, however, unaware of any other study that has shown that STN DBS reduces the risk of polypharmacy. This is an important new finding from the pilot trial of DBS in early-stage PD,1,2 given the well-established adverse effects associated with polypharmacy in older adults.3,4 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 disease: Five-year outcomes. Neurology 2020;95:e393–e401.
Hacker ML, Currie AD, Molinari AL, et al. Subthalamic Nucleus Deep Brain Stimulation May Reduce Medication Costs in Early Stage Parkinson’s Disease. J Parkinsons Dis 2016;6:125–31.
Niehoff KM, Mecca MC, Fried TR. Medication appropriateness criteria for older adults: a narrative review of criteria and supporting studies. Ther Adv drug Saf 2019;10: 2042098618815431.
Müller-Rebstein S, Trenkwalder C, Ebentheuer J, et al. Drug Safety Analysis in a Real-Life Cohort of Parkinson’s Disease Patients with Polypharmacy. CNS Drugs 2017;31:1093–1102.
We appreciate the interest in our research1 of subthalamic nucleus (STN) deep brain stimulation (DBS) in early-stage Parkinson disease (PD). As noted in our publication, “Participants returned to the Vanderbilt Clinical Research Center (CRC) for annual outpatient study visits at years 3, 4, and 5, undergoing evaluations similar to the day 1 assessments conducted during the initial 2-year trial.” We would like to clarify that off-therapy tremor scores were not collected in follow-up years 3, 4, or 5 due to a lack of funding. We agree that reduced dyskinesia was expected due to the long-standing history of STN DBS being a potent therapy to reduce medications, and therefore dyskinesia, in advanced-stage Parkinson disease. We are, however, unaware of any other study that has shown that STN DBS reduces the risk of polypharmacy. This is an important new finding from the pilot trial of DBS in early-stage PD,1,2 given the well-established adverse effects associated with polypharmacy in older adults.3,4 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