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Subject: Quality of Life in Elderly Parkinson's Patients Not Improved by Deep Brain Stimulation Date: Wednesday 16 May 2007 19:33 By Will Boggs, MD NEW YORK (Reuters Health) May 04 - Deep brain stimulation of the subthalamic nucleus (DBS-STN) reduces motor complications in elderly patients with severe Parkinson disease, but it does not improve their quality of life, according to a report in the April 24th issue of Neurology. "Lack of quality-of-life improvement ... raises the question of whether DBS-STN is appropriate for the parkinsonian population over 65 years old," Dr. Philippe-Pierre Derost from Hopital Gabriel Montpied, Clermont-Ferrand, France told Reuters Health. Dr. Derost and associates investigated the clinical effects, safety, and quality of life after bilateral DBS-STN in 87 patient's with Parkinson's disease -- 53 who were younger than 65 years of age, and 34 who were 65 or older. Both groups of patients experienced dramatic improvements in motor complications, the authors report, with no significant difference between the groups. Unlike the younger patients, however, older patients showed a significant worsening in Schwab and England Scale scores, a measure of capacity to perform daily chores. Moreover, the results indicate, young patients fared significantly better than old patients in several quality-of-life dimensions, including mobility, activities of daily living, stigma, cognition, and communication. In these five dimensions, young patients experienced improvements, while old patients showed stabilization or worsening from the third postoperative month. Adverse events did not differ significantly between the two groups, the researchers say. "The absence of improvement of quality of life in the old population was surprising since motor complications were reduced similarly in both groups of patients," Dr. Derost said. "In fact," he explained, "lack of improvement of quality of life in patients aged more than 65 years old at time of surgery is probably due to a worsening of axial symptoms ... responsible for postural instability, dysarthria, difficulty swallowing, and so on. This effect probably offsets improvement in quality of life due to the decrease of motor complications." This result "should lead us to exclude patients aged more than 65 years for DBS," Dr. Derost suggested. "However, there is still some variability in our elderly patient sample." Factors other than age at time of surgery could explain this variability, as results were favorable in some of the elderly patients, Dr. Derost said. "Unfortunately, such predictive factors are still not identified. A study is being performed in our department to detect these potential predictive factors to help determine who should undergo DBS." Neurology 2007;68:1345-1355. ------------------------------------------------------- ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn