Randomized trial of deep brain stimulation for Parkinson disease: Thirty-six-month outcomes

Frances M. Weaver, Kenneth A Follett, Matthew Stern, Ping Luo, Crystal L. Harris, Kwan Hur, William J. Marks, Johannes Rothlind, Oren Sagher, Claudia Moy, Rajesh Pahwa, Kim Burchiel, Penelope Hogarth, Eugene C. Lai, John E. Duda, Kathryn Holloway, Ali Samii, Stacy Horn, Jeff M. Bronstein, Gatana StonerPhilip A. Starr, Richard Simpson, Gordon Baltuch, Antonio De Salles, Grant D. Huang, Domenic J. Reda

Research output: Contribution to journalArticle

206 Citations (Scopus)

Abstract

Objectives: Our objective was to compare long-term outcomes of deep brain stimulation (DBS) of the globus pallidus interna (GPi) and subthalamic nucleus (STN) for patients with Parkinson disease (PD) in a multicenter randomized controlled trial. Methods: Patients randomly assigned to GPi (n = 89) or STN DBS (n = 70) were followed for 36 months. The primary outcome was motor function on stimulation/off medication using the Unified Parkinson's Disease Rating Scale motor subscale. Secondary outcomes included quality of life and neurocognitive function. Results: Motor function improved between baseline and 36 months for GPi (41.1 to 27.1; 95% confidence interval [CI] -16.4 to -10.8; p < 0.001) and STN (42.5 to 29.7; 95% CI -15.8 to -9.4; p < 0.001); improvements were similar between targets and stable over time (p = 0.59). Health-related quality of life improved at 6 months on all subscales (all p values significant), but improvement diminished over time. Mattis Dementia Rating Scale scores declined faster for STN than GPi patients (p = 0.01); other neurocognitive measures showed gradual decline overall. Conclusions: The beneficial effect of DBS on motor function was stable and comparable by target over 36 months. Slight declines in quality of life following initial gains and gradual decline in neurocognitive function likely reflect underlying disease progression and highlight the importance of nonmotor symptoms in determining quality of life. Classification of Evidence: This study provides Class III evidence that improvement of motor symptoms of PD by DBS remains stable over 3 years and does not differ by surgical target.

Original languageEnglish (US)
Pages (from-to)55-65
Number of pages11
JournalNeurology
Volume79
Issue number1
DOIs
StatePublished - Jul 3 2012

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Subthalamic Nucleus
Globus Pallidus
Deep Brain Stimulation
Parkinson Disease
Quality of Life
Confidence Intervals
Dementia
Disease Progression
Randomized Controlled Trials
Parkinson's Disease
Nucleus

ASJC Scopus subject areas

  • Clinical Neurology

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Randomized trial of deep brain stimulation for Parkinson disease : Thirty-six-month outcomes. / Weaver, Frances M.; Follett, Kenneth A; Stern, Matthew; Luo, Ping; Harris, Crystal L.; Hur, Kwan; Marks, William J.; Rothlind, Johannes; Sagher, Oren; Moy, Claudia; Pahwa, Rajesh; Burchiel, Kim; Hogarth, Penelope; Lai, Eugene C.; Duda, John E.; Holloway, Kathryn; Samii, Ali; Horn, Stacy; Bronstein, Jeff M.; Stoner, Gatana; Starr, Philip A.; Simpson, Richard; Baltuch, Gordon; De Salles, Antonio; Huang, Grant D.; Reda, Domenic J.

In: Neurology, Vol. 79, No. 1, 03.07.2012, p. 55-65.

Research output: Contribution to journalArticle

Weaver, FM, Follett, KA, Stern, M, Luo, P, Harris, CL, Hur, K, Marks, WJ, Rothlind, J, Sagher, O, Moy, C, Pahwa, R, Burchiel, K, Hogarth, P, Lai, EC, Duda, JE, Holloway, K, Samii, A, Horn, S, Bronstein, JM, Stoner, G, Starr, PA, Simpson, R, Baltuch, G, De Salles, A, Huang, GD & Reda, DJ 2012, 'Randomized trial of deep brain stimulation for Parkinson disease: Thirty-six-month outcomes', Neurology, vol. 79, no. 1, pp. 55-65. https://doi.org/10.1212/WNL.0b013e31825dcdc1
Weaver, Frances M. ; Follett, Kenneth A ; Stern, Matthew ; Luo, Ping ; Harris, Crystal L. ; Hur, Kwan ; Marks, William J. ; Rothlind, Johannes ; Sagher, Oren ; Moy, Claudia ; Pahwa, Rajesh ; Burchiel, Kim ; Hogarth, Penelope ; Lai, Eugene C. ; Duda, John E. ; Holloway, Kathryn ; Samii, Ali ; Horn, Stacy ; Bronstein, Jeff M. ; Stoner, Gatana ; Starr, Philip A. ; Simpson, Richard ; Baltuch, Gordon ; De Salles, Antonio ; Huang, Grant D. ; Reda, Domenic J. / Randomized trial of deep brain stimulation for Parkinson disease : Thirty-six-month outcomes. In: Neurology. 2012 ; Vol. 79, No. 1. pp. 55-65.
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AU - Weaver, Frances M.

AU - Follett, Kenneth A

AU - Stern, Matthew

AU - Luo, Ping

AU - Harris, Crystal L.

AU - Hur, Kwan

AU - Marks, William J.

AU - Rothlind, Johannes

AU - Sagher, Oren

AU - Moy, Claudia

AU - Pahwa, Rajesh

AU - Burchiel, Kim

AU - Hogarth, Penelope

AU - Lai, Eugene C.

AU - Duda, John E.

AU - Holloway, Kathryn

AU - Samii, Ali

AU - Horn, Stacy

AU - Bronstein, Jeff M.

AU - Stoner, Gatana

AU - Starr, Philip A.

AU - Simpson, Richard

AU - Baltuch, Gordon

AU - De Salles, Antonio

AU - Huang, Grant D.

AU - Reda, Domenic J.

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N2 - Objectives: Our objective was to compare long-term outcomes of deep brain stimulation (DBS) of the globus pallidus interna (GPi) and subthalamic nucleus (STN) for patients with Parkinson disease (PD) in a multicenter randomized controlled trial. Methods: Patients randomly assigned to GPi (n = 89) or STN DBS (n = 70) were followed for 36 months. The primary outcome was motor function on stimulation/off medication using the Unified Parkinson's Disease Rating Scale motor subscale. Secondary outcomes included quality of life and neurocognitive function. Results: Motor function improved between baseline and 36 months for GPi (41.1 to 27.1; 95% confidence interval [CI] -16.4 to -10.8; p < 0.001) and STN (42.5 to 29.7; 95% CI -15.8 to -9.4; p < 0.001); improvements were similar between targets and stable over time (p = 0.59). Health-related quality of life improved at 6 months on all subscales (all p values significant), but improvement diminished over time. Mattis Dementia Rating Scale scores declined faster for STN than GPi patients (p = 0.01); other neurocognitive measures showed gradual decline overall. Conclusions: The beneficial effect of DBS on motor function was stable and comparable by target over 36 months. Slight declines in quality of life following initial gains and gradual decline in neurocognitive function likely reflect underlying disease progression and highlight the importance of nonmotor symptoms in determining quality of life. Classification of Evidence: This study provides Class III evidence that improvement of motor symptoms of PD by DBS remains stable over 3 years and does not differ by surgical target.

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