Brain op boost for Parkinson's
Thursday April 29th, 2010
Patients with advanced Parkinson's Disease who combine deep brain stimulation with drug treatment do better after one year than those who receive just medical drug treatment, researchers have reported.
A report in The Lancet by researchers from the University of Birmingham, UK, says the self-reported experience of patients shows that that surgery is an important treatment option that should be offered to those people most likely to benefit.
Recent advances in imaging have improved the accuracy of surgical interventions for Parkinson's, and particularly that of deep brain stimulation, in which electrical impulses are delivered into the brain to modulate areas that control movement.
Surgery has become a common treatment when drug therapy is no longer providing relief from symptoms, but there are few good quality randomised trials that have compared the effects of surgery with other medical therapies.
University researchers, working with colleagues across the UK, conducted a randomised trial to examine the effects of deep brain stimulation and medical therapy on the lives of people with advanced PD.
A total of 366 patients from 13 neurosurgical centres in the UK were randomly assigned to receive surgery and best medical therapy or best medical therapy alone. Patients completed self-reported scores on scales measuring quality of life (the 39-item Parkinson's disease questionnaire), functioning (unified Parkinson's disease rating scale), and cognitive status at one year after treatment.
Results showed that deep brain stimulation improves quality of life more than medical therapy alone - by 5.0 points in the surgery group as opposed to 0.3 points in the medical therapy alone group.
Patients in the surgery group also experienced significant improvements in mobility, activities of daily living and bodily discomfort. Surgery also reduced problems with uncontrolled movements (dyskinesia) and off time (time when motor symptoms are not being adequately controlled).
However, more patients in the surgery group experienced serious adverse events than those in the medical therapy group. 36 surgery patients had 43 surgery-related serious adverse events, the most common being infection, while one patient died as a result of the procedure. 20 surgery patients and 13 medical therapy patients experienced serious adverse events related to PD and drug treatment, the most common of which was worsening of PD symptoms or uncontrolled PD symptoms.
"Surgery is likely to remain an important treatment option for patients with PD, especially if the way in which deep brain stimulation exerts its therapeutic benefits is better understood, if its use can be optimised by better electrode placement and settings, and if patients who would have the greatest benefit can be better identified," the authors conclude.
Lancet Neurology June 2010
Tags: Brain & Neurology | UK News
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