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] > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: > mailto:[log in to unmask] > In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn