Effects of electrical stimulation in Parkinson's disease may differ by
treatment site
WESTPORT, Dec 07, 1999 (Reuters Health) - In patients with advanced
Parkinson's disease, the effects of deep brain electrical stimulation
seem to differ according to the site treated, but neither method is
clearly superior to the other, according to the results of the first
randomized, blinded study of this issue.
Led by Dr. Kim J. Burchiel, researchers at the Oregon Health Sciences
University in Portland compared deep brain stimulation of either the
global pallidus internus or the subthalamic nucleus in 10 patients with
advanced Parkinson's disease.
All patients had levodopa-induced dyskinesia, fluctuations in response
to the drug, or both complications. At regular intervals over a 12-month
period, the investigators assessed the patients' neurological condition
on and off levodopa.
After 12 months, during "off" periods both groups showed improvements of
approximately 40% in Unified Parkinson's Disease Rating Scale motor
scores, according to the authors. "Rigidity, tremor, and bradykinesia
improved in both groups," they write in the December issue of
Neurosurgery.
During "on" periods, motor scores improved to a greater extent in
patients who underwent stimulation of the global pallidus internus, and
axial symptoms improved in this group only, Dr. Burchiel's team
observed. "By far" the major difference, however, was that the levodopa
requirement was reduced only among patients with subthalamic nucleus
implants, and dyskinesia improved more in this group.
"There were no serious intraoperative complications among patients in
either group," the researchers report. Both types of stimulation appear
to be safe and effective, they say.
The investigators call for a larger study "...to establish conclusively
whether there is an important difference in efficacy between [global
pallidus internus and subthalamic nucleus] stimulation and to determine
whether some symptoms respond better to stimulation of one target or
another."
Neurosurgery 1999;45:1375-1384.
1999 Reuters Limited
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Judith Richards, London, Ontario, Canada
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Judith Richards, London, Ontario, Canada
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^^^^
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