PT - JOURNAL ARTICLE AU - Aristide Merola AU - Laura Rizzi AU - Maurizio Zibetti AU - Carlo Alberto Artusi AU - Elisa Montanaro AU - Serena Angrisano AU - Michele Lanotte AU - Mario Giorgio Rizzone AU - Leonardo Lopiano TI - Medical therapy and subthalamic deep brain stimulation in advanced Parkinson's disease: a different long-term outcome? AID - 10.1136/jnnp-2013-305271 DP - 2014 May 01 TA - Journal of Neurology, Neurosurgery & Psychiatry PG - 552--559 VI - 85 IP - 5 4099 - http://jnnp.bmj.com/content/85/5/552.short 4100 - http://jnnp.bmj.com/content/85/5/552.full SO - J Neurol Neurosurg Psychiatry2014 May 01; 85 AB - 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.