Study: Deep Brain Stimulation Is More Effective but Riskier Than Other Treatments for Advanced Parkinson's Disease
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Deep brain stimulation requires the surgical implantation of electrodes and a device in the brain in order to electrically stimulate certain brain regions.
The new study, published in The Journal of the American Medical Association, shows better improvements in disability and quality of life with deep brain stimulation, compared to other state-of-the-art treatments for patients with advanced Parkinson's disease.
But there were also more serious side effects in patients who got deep brain stimulation.
"Physicians must continue to weigh the potential short-term and long-term risks with the benefits of deep brain stimulation in each patient," write the researchers, who included Frances Weaver, PhD, of the Center for Management of Complex Chronic Care at the VA Hospital in Hines, Ill.
Deep Brain Stimulation for Parkinson's
Deep brain stimulation isn't a new treatment for Parkinson's disease.
The new study included 255 U.S. adults with advanced Parkinson's disease. About three quarters of them were younger than 70.
First, the patients kept diaries of their Parkinson's symptoms and neurologists rated the severity of their Parkinson's symptoms when the patients weren't on medication.
Next, the patients were randomly split into two groups. One group got deep brain stimulation, in which surgeons implant a device in the brain to electrically stimulate certain parts of the brain.
For comparison, patients in the other group got state-of-the-art Parkinson's treatment that didn't involve deep brain stimulation.
Six months later, the patients in the deep brain stimulation group had gained about four more hours of daily time without movement problems, as well as better quality of life. The comparison group showed no such improvements.
Deep brain stimulation showed benefits for patients younger than 70 and also for older patients.
Serious side effects were more common with deep brain stimulation than with other treatment.
One of the deep brain stimulation patients died of complications from the implantation surgery. Another deep brain stimulation patient was institutionalized for about five months after deep brain stimulation because of "impaired activities of daily living and occasional delusions or hallucinations," Weaver and colleagues report.
A total of 49 patients in the deep brain stimulation group had at least one serious side effect, compared to 15 patients in the comparison group.
Infections at the surgical site were the most common serious adverse event. Falls were also more common among the deep brain stimulation patients.
The findings "convincingly confirmed the six-month efficacy of deep brain stimulation for advanced Parkinson's disease in the largest patient group studied thus far," states an editorial published with the study.
"However, this study, along with previous research on this therapy, shows that such progress cannot be made without costs in terms of adverse events," says editorialist Gunther Deuschl, MD, PhD, of the neurology department at Germany's Universitatsklinikum Schleswig-Holstein.
In the journal, Deuschl and several of the researchers note financial ties to medical companies including Medtronic, the maker of the deep brain stimulation device used in the study.
SOURCES: Weaver, F. The Journal of the American Medical Association, Jan. 7, 2009; vol 301: pp 63-73. Deuschl, D. The Journal of the American Medical Association, Jan. 7, 2009; vol 301: pp 104-105.
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