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DBS Multicenter Four-Year Follow-up Bilateral deep brain stimulation in Parkinson's disease: A multicentre study with 4 years follow-up MC Rodriguez-Oros, JA Obeso, AE Lang, JL Houeto, P Pollak, S Rehncrona, J Kulisevsky, A Albanese, J Volkmann, MI Hariz, NP Quinn, JD Speelman, J Furidi, I Zamarbide, A Gironell, J Molet, B Pascual-Sedano, B Pidoux, AM Bonnet, Y Agid, J Xie, A-L Benabid, AM Lozano, J Saint-Cyr, L Romito, MF Contarino, M Scerrati, V Fraix, N Van Blercom Brain 2005;128:2240-2249 Deep brain stimulation of either the subthalamic nucleus or the globus pallidus continues to provide significant benefit after 4 years of treatment, according to the study. Long-term follow-up was conducted at 8 centers in Europe and Canada, of patients originally enrolled in a multicenter trial of deep brain stimulation. Patients were enrolled if they had been treated for a minimum of 3 years and less than 5 years. Forty-nine of 68 DBS-STN patients were available for follow-up, and 20 of 37 DBS-GPi patients. Compared to GPi patients, STN patients at baseline were slightly older, had slightly higher UPDRS off-medication scores, and slightly higher daily levodopa equivalent doses. Results showed: --for STN, at baseline the percent of waking time spent off, on with dyskinesias, and on without dyskinesias was 53%, 23%, and 24%, respectively. At 3-4 years, it was 23%, 13%, and 64%. --For GPi, these same percentages were 37%, 37%, and 26% at baseline, and 21%, 10%, and 69% at 3-4 years. --for STN, UPDRS off-medication motor scores were 56.7 at baseline and 28.6 at 3-4 years (with stimulation on). For GPi, the scores were 51.7 and 31.7. --for STN, levodopa equivalent dose intake fell from 1309 mg/day to 859 mg/day (p<0.001). For GPi, it rose from 1074 to 1418 (difference not significant). Persistent adverse events were reported in 53% of STN patients, and 35% of GPi patients. The severity of adverse events did not warrant suspension of DBS in any case. Major adverse events present at 3-4 years included: --memory decline and/or psychiatric disturbance in 12 STN patients (4 mild, 7 moderate, 1 severe) and 1 GPi patient (mild). --moderate depression in 3 STN patients --speech difficulties in 9 STN patients (2 mild, 3 moderate, 4 severe) and 1 GPi patient (severe) --falls and/or balance disturbances in 8 STN patients (2 mild, 5 moderate, 1 severe) --gait disorders in 9 STN patients (2 mild, 3 moderate, 4 severe) The authors note that while the adverse events encountered are also seen in patients on medication alone, the higher rate in STN patients versus GPi patients "implies some specificity to the findings." The study was not designed to evaluate the relative contributions to risk of the procedure or initial severity of PD or other factors, however. A Commentary by Hans Joachim Freund accompanies the report. Sponsored by Medtronic. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn