 |
|
Pallidal vs Subthalamic Nucleus Deep Brain Stimulation in Parkinson Disease
Valerie C. Anderson, PhD;
Kim J. Burchiel, MD;
Penelope Hogarth, MD;
Jacques Favre, MD;
John P. Hammerstad, MD
Arch Neurol. 2005;62:554-560.
Background Deep brain stimulation (DBS) of the globus pallidus interna (GPi) and subthalamic nucleus (STN) has been reported to relieve motor symptoms and levodopa-induced dyskinesia in patients with advanced Parkinson disease (PD). Although it has been suggested that stimulation of the STN may be superior to stimulation of the GPi, comparative trials are limited.
Objective To extend our randomized, blinded pilot comparison of the safety and efficacy of STN and GPi stimulation in patients with advanced PD.
Design This study represents the combined results from our previously published, randomized, blinded, parallel-group pilot study and additional patients enrolled in our single-center extension study.
Setting Oregon Health and Science University in Portland.
Patients Twenty-three patients with idiopathic PD, levodopa-induced dyskinesia, and response fluctuations were randomized to implantation of bilateral GPi or STN stimulators. Patients and evaluating clinicians were blinded to stimulation site. All patients were tested preoperatively while taking and not taking medications and after 3, 6, and 12 months of DBS.
Main Outcome Measures Postoperatively, response of symptoms to DBS, medication, and combined medication and DBS was evaluated. Twenty patients (10 in the GPi group and 10 in the STN group) completed 12-month follow-up.
Results Off-medication Unified Parkinson’s Disease Rating Scale motor scores were improved after 12 months of both GPi and STN stimulation (39% vs 48%). Bradykinesia tended to improve more with STN than GPi stimulation. No improvement in on-medication function was observed in either group. Levodopa dose was reduced by 38% in STN stimulation patients compared with 3% in GPi stimulation patients (P = .08). Dyskinesia was reduced by stimulation at both GPi and STN (89% vs 62%). Cognitive and behavioral complications were observed only in combination with STN stimulation.
Conclusion Stimulation of either the GPi or STN improves many features of advanced PD. It is premature to exclude GPi as an appropriate target for DBS in patients with advanced disease.
Author Affiliations: Departments of Neurological Surgery (Drs Anderson and Burchiel) and Neurology (Drs Hogarth and Hammerstad), Oregon Health and Science University, Portland; and Forum Centre, Montreux, Switzerland (Dr Favre).
RELATED LETTERS
Pallidal vs Subthalamic Deep Brain Stimulation for Parkinson Disease: Winner and Loser or a Sharing of Honors?
Adolfo Minguez-Castellanos and Francisco Escamilla-Sevilla
Arch Neurol. 2005;62(10):1642-1643.
EXTRACT
| FULL TEXT
Pallidal vs Subthalamic Deep Brain Stimulation for Parkinson Disease: Winner and Loser or a Sharing of Honors?—Reply
Penelope Hogarth, Valerie Anderson, and John Hammerstad
Arch Neurol. 2005;62(10):1643.
EXTRACT
| FULL TEXT
Multisite Randomized Trial of Deep Brain Stimulation
Kenneth Follett, Frances Weaver, Matthew Stern, William Marks, Penelope Hogarth, Katherine Holloway, Jeff Bronstein, John Duda, Stacy Horn, Eugene Lai, and Ali Samii
Arch Neurol. 2005;62(10):1643-1644.
EXTRACT
| FULL TEXT
Multisite Randomized Trial of Deep Brain Stimulation—Reply
Michael S. Okun and Kelly D. Foote
Arch Neurol. 2005;62(10):1644-1645.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Subthalamic Nucleus vs Globus Pallidus Interna Deep Brain Stimulation, the Rematch: Will Pallidal Deep Brain Stimulation Make a Triumphant Return?
Michael S. Okun and Kelly D. Foote
Arch Neurol. 2005;62(4):533-536.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Neuronal Firing Rates and Patterns in the Globus Pallidus Internus of Patients With Cervical Dystonia Differ From Those With Parkinson's Disease
Tang et al.
J. Neurophysiol. 2007;98:720-729.
ABSTRACT
| FULL TEXT
Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease
Stefani et al.
Brain 2007;130:1596-1607.
ABSTRACT
| FULL TEXT
Levodopa-induced dyskinesia in Parkinson's disease: clinical features, pathogenesis, prevention and treatment
Thanvi et al.
Postgrad. Med. J. 2007;83:384-388.
ABSTRACT
| FULL TEXT
Pallidal vs Subthalamic Deep Brain Stimulation for Parkinson Disease: Winner and Loser or a Sharing of Honors?--Reply
Hogarth et al.
Arch Neurol 2005;62:1643-1643.
FULL TEXT
Multisite Randomized Trial of Deep Brain Stimulation--Reply
Okun and Foote
Arch Neurol 2005;62:1644-1645.
FULL TEXT
Pallidal vs Subthalamic Deep Brain Stimulation for Parkinson Disease: Winner and Loser or a Sharing of Honors?
Minguez-Castellanos and Escamilla-Sevilla
Arch Neurol 2005;62:1642-1643.
FULL TEXT
Multisite Randomized Trial of Deep Brain Stimulation
Follett et al.
Arch Neurol 2005;62:1643-1644.
FULL TEXT
|
