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Research paper
Medical therapy and subthalamic deep brain stimulation in advanced Parkinson's disease: a different long-term outcome?
  1. Aristide Merola,
  2. Laura Rizzi,
  3. Maurizio Zibetti,
  4. Carlo Alberto Artusi,
  5. Elisa Montanaro,
  6. Serena Angrisano,
  7. Michele Lanotte,
  8. Mario Giorgio Rizzone,
  9. Leonardo Lopiano
  1. Department of Neuroscience, University of Torino, Turin, Italy
  1. Correspondence to Dr Aristide Merola, Department of Neuroscience, University of Torino, Via Cherasco 15, Turin 10126, Italy; aristidemerola{at}hotmail.com

Abstract

Objectives Few clinical trials reported the comparative short-term efficacy of subthalamic nucleus deep brain stimulation (STN-DBS) versus medical therapy in advanced Parkinson's disease (PD). However, the comparative efficacy, safety and the potential disease-modifying effect of these treatments have not been investigated over a longer follow-up period.

Methods In this study, we organised a ‘retrospective control group’ to compare medical and surgical therapies over a long-term period. We assessed a group of PD patients suitable for STN-DBS but successively treated with medical therapies for reasons not related to PD, and a group of similar consecutive STN-DBS patients. We thus obtained two groups comparable at baseline, which were re-evaluated after an average follow-up of 6 years (range 4–11).

Results Patients treated with STN-DBS showed a long-lasting superior clinical efficacy on motor fluctuations, with a significant reduction in the average percentage of the waking day spent in ‘OFF’ and in the duration and disability of dyskinesia. Moreover, operated patients showed a better outcome in the activities of daily living in ‘Medication-OFF’ condition. On the other hand, a similar progression of motor score and cognitive/behavioural alterations was observed between the two groups, apart from phonemic verbal fluency, which significantly worsened in STN-DBS patients.

Conclusions To our knowledge, this is the first long-term comparison between medical and surgical therapies; a superior efficacy of STN-DBS was observed on motor disability, while no significant differences were observed in the progression of motor symptoms and, apart from phonemic verbal fluency, of neuropsychological alterations.

  • Parkinson'S Disease
  • Electrical Stimulation
  • Interventional
  • Movement Disorders

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