from this article it would appear to be "improved motor functions and 
quality of life" - more "ON" time.

since I don't take any PD meds its impossible to tell for me.   Tremor was 
the only symptom it definitely helped.  I don't know how bad my other 
symptoms would be without  DBS.

ray
Rayilyn Brown
Director AZNPF
Arizona Chapter National Parkinson Foundation
[log in to unmask]

--------------------------------------------------
From: "kbachn" <[log in to unmask]>
Sent: Sunday, January 11, 2009 4:06 AM
To: <[log in to unmask]>
Subject: Re: DBS for advanced PD

> what are the "behavioral effects of stimulation"
>
> tks
>
>
> ----- Original Message ----- 
> From: "rayilynlee" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, January 10, 2009 2:25 PM
> Subject: DBS for advanced PD
>
>
>> Deep Brain Stimulation Treatment For Advanced Parkinson's Disease 
>> Patients Provides Benefits, Risks
>> ScienceDaily (Jan. 9, 2009) - Patients with advanced Parkinson disease 
>> (PD) who received deep brain stimulation treatment had more improvement 
>> in movement skills and quality of life after six months than patients who 
>> received other medical therapy, but also had a higher risk of a serious 
>> adverse events, according to a new study.
>> Deep brain stimulation is a surgical treatment involving the implantation 
>> of electrodes that send electrical stimulation to specific parts of the 
>> brain to reduce involuntary movements and tremors. It is the surgical 
>> intervention of choice when PD motor (movement) complications are 
>> inadequately managed with medications, according to background 
>> information in the article. "However, recent reports highlighting 
>> unexpected behavioral effects of stimulation suggest that deep brain 
>> stimulation, while improving motor function, may have other less 
>> desirable consequences," the authors write. They add that there are few 
>> randomized trials comparing treatments, and most studies exclude older 
>> patients.
>> Frances M. Weaver, Ph.D., of Hines VA Hospital, Hines, Ill., and 
>> colleagues conducted a randomized trial to compare the benefits and risks 
>> of deep brain stimulation with those of best medical therapy for 
>> patients, of a wide age range, with PD. A total of 255 patients with PD 
>> were enrolled; 25 percent were age 70 years or older. The participants 
>> were randomized to receive bilateral deep brain stimulation with leads of 
>> the stimulation device implanted in the following locations of the brain: 
>> subthalamic nucleus (n = 60) or globus pallidus (n = 61); or received 
>> best medical therapy (n = 134), which included management by movement 
>> disorder neurologists, who monitored medication use and 
>> nonpharmacological therapy (e.g., physical, occupational, and speech 
>> therapy).
>> The researchers found that at 6 months, deep brain stimulation patients 
>> gained an average of 4.6 hours per day of on time (the time of good 
>> symptom control or unimpeded motor function) without troubling dyskinesia 
>> (involuntary movements), while the average change for the best medical 
>> therapy group was 0 hours. Motor function improved significantly with 
>> deep brain stimulation compared with best medical therapy, with 71 
>> percent of deep brain stimulation patients vs. 32 percent of best medical 
>> therapy patients experiencing clinically meaningful motor function 
>> improvements at 6 months, while 3 percent of deep brain stimulation 
>> patients and 21 percent of best medical therapy patients had clinically 
>> worsening scores.
>> Compared with patients in the best medical therapy group, patients in the 
>> deep brain stimulation group experienced significant improvements in the 
>> summary measure of quality of life and on 7 of 8 PD quality-of-life 
>> scores. Neurocognitive testing revealed small decrements in some areas of 
>> information processing for patients receiving deep brain stimulation vs. 
>> best medical therapy.
>> The overall risk of experiencing a serious adverse event was 3.8 times 
>> higher in deep brain stimulation patients than in best medical therapy 
>> patients. Forty-nine deep brain stimulation patients (40 percent) 
>> experienced 82 serious adverse events. Fifteen best medical therapy 
>> patients (11 percent) experienced 19 serious adverse events. The most 
>> common serious adverse event was surgical site infection, with other 
>> serious adverse events including nervous system disorders, psychiatric 
>> disorders, device-related complications and cardiac disorders.
>> "The clinical significance of the adverse events and minor neurocognitive 
>> changes observed in patients in the deep brain stimulation group and, 
>> more importantly, whether patients who undergo deep brain stimulation 
>> view improvement in motor function and quality of life as outweighing 
>> adverse events, remain to be explored. More detailed analyses of adverse 
>> events and neurocognitive functioning following the conclusion of phase 2 
>> of this study will shed light on these issues. Caution should be 
>> exercised, however, against overstating or understating the risks of deep 
>> brain stimulation for patients with PD. Physicians must continue to weigh 
>> the potential short-term and long-term risks with the benefits of deep 
>> brain stimulation in each patient," the authors conclude.
>> Editorial: Neurostimulation for Parkinson Disease
>> In an accompanying editorial, Günther Deuschl, M.D., Ph.D., of the 
>> Universitätsklinikum Schleswig-Holstein, Kiel, Germany, comments on the 
>> findings of Weaver and colleagues.
>> "Although deep brain stimulation is the most important innovation for 
>> treatment of advanced PD since the discovery of levodopa [drug used to 
>> treat PD], many questions are still unanswered. For instance, the optimal 
>> timing for the implantation is unknown. The majority of patients undergo 
>> deep brain stimulation surgery more than 10 years after disease onset 
>> when the patients are already incapable of working and when the 
>> disease-related psychosocial decline has already begun. As quality of 
>> life is improved with this treatment it may improve psychosocial 
>> functioning in general for these advanced stages. With the aging of the 
>> general population, PD will become even more common and patients with PD 
>> will get older. Therefore, the present results showing similar efficacy 
>> and tolerability of deep brain stimulation in younger and older patients 
>> must be replicated because it is at variance with some other reports 
>> demonstrating lower rates of operative and postoperative complications in 
>> younger patients."
>> "Overall the results of this important study by Weaver et al have 
>> convincingly confirmed the 6-month efficacy of deep brain stimulation for 
>> advanced PD in the largest patient group studied thus far. However, this 
>> study, along with previous research on this therapy, shows that such 
>> progress cannot be made without costs in terms of adverse effects."
>>
>> JAMA and Archives Journals (2009, January 9). Deep Brain Stimulation 
>> Treatment For Advanced Parkinson's Disease Patients Provides Benefits, 
>> Risks. ScienceDaily. Retrieved January 10, 2009, from 
>> http://www.sciencedaily.com­ /releases/2009/01/090106161510.htm
>>
>> Rayilyn Brown
>> Director AZNPF
>> Arizona Chapter National Parkinson Foundation
>> [log in to unmask]
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