RT Journal Article
SR Electronic
T1 Effects of deep brain stimulation on rest tremor progression in early stage Parkinson disease
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e463
OP e471
DO 10.1212/WNL.0000000000005903
VO 91
IS 5
A1 Hacker, Mallory L.
A1 DeLong, Mahlon R.
A1 Turchan, Maxim
A1 Heusinkveld, Lauren E.
A1 Ostrem, Jill L.
A1 Molinari, Anna L.
A1 Currie, Amanda D.
A1 Konrad, Peter E.
A1 Davis, Thomas L.
A1 Phibbs, Fenna T.
A1 Hedera, Peter
A1 Cannard, Kevin R.
A1 Drye, Lea T.
A1 Sternberg, Alice L.
A1 Shade, David M.
A1 Tonascia, James
A1 Charles, David
YR 2018
UL http://n.neurology.org/content/91/5/e463.abstract
AB Objective To evaluate whether the progression of individual motor features was influenced by early deep brain stimulation (DBS), a post hoc analysis of Unified Parkinson's Disease Rating Scale–III (UPDRS-III) score (after a 7-day washout) was conducted from the 2-year DBS in early Parkinson disease (PD) pilot trial dataset.Methods The prospective pilot trial enrolled patients with PD aged 50–75 years, treated with PD medications for 6 months–4 years, and no history of dyskinesia or other motor fluctuations, who were randomized to receive optimal drug therapy (ODT) or DBS plus ODT (DBS + ODT). At baseline and 6, 12, 18, and 24 months, all patients stopped all PD therapy for 1 week (medication and stimulation, if applicable). UPDRS-III “off” item scores were compared between the ODT and DBS + ODT groups (n = 28); items with significant between-group differences were analyzed further.Results UPDRS-III “off” rest tremor score change from baseline to 24 months was worse in patients receiving ODT vs DBS + ODT (p = 0.002). Rest tremor slopes from baseline to 24 months favored DBS + ODT both “off” and “on” therapy (p < 0.001, p = 0.003, respectively). More ODT patients developed new rest tremor in previously unaffected limbs than those receiving DBS + ODT (p = 0.001).Conclusions These results suggest the possibility that DBS in early PD may slow rest tremor progression. Future investigation in a larger cohort is needed, and these findings will be tested in the Food and Drug Administration–approved, phase III, pivotal, multicenter clinical trial evaluating DBS in early PD.Classification of evidence This study provides Class II evidence that for patients with early PD, DBS may slow the progression of rest tremor.CI=confidence interval; DBS=deep brain stimulation; FDA=Food and Drug Administration; HR=hazard ratio; LEDD=levodopa equivalent daily dose; ODT=optimal drug therapy; PD=Parkinson disease; STN=subthalamic nucleus; UPDRS-III=Unified Parkinson's Disease Rating Scale, part III