Neurology. 2006 Dec 6; [Epub ahead of print] Related Articles, Links


Neurosurgery at an earlier stage of Parkinson disease. A randomized, controlled trial.

Schupbach WM, Maltete D, Houeto JL, Tezenas du Montcel S, Mallet L, Welter ML, Gargiulo M, Behar C, Bonnet AM, Czernecki V, Pidoux B, Navarro S, Dormont D, Cornu P, Agid Y.

From the Centre d'Investigation Clinique (Y.A., C.B., A.M.B., V.C., M.G., J.L.H., L.M., D.M., W.M.M.S., M.L.W.), Federation de Neurologie and National Institute of Health and Medical Research (INSERM) Unit 679, Service de Neuroradiologie (D.D.), Service des Explorations Fonctionnelles Neurologiques (B.P.), Service de Neurochirurgie (P.C., S.N.), Groupe Hospitalier Pitie-Salpetriere, Paris, France; Department of Biostatistics and Medical Information (S.T.d.M.,), Pitie-Salpetriere Medical University, Paris, France; Centre Hospitalier (J.L.H.), Poitiers, France; and Centre Hospitalier (D.M.), Rouen, France.

Abstract-- BACKGROUND: Stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson disease (PD) and is currently performed after a mean disease duration of 14 years, when severe motor complications have resulted in marked loss of quality of life. We examined whether surgery at an early stage would maintain quality of life as well as improve motor function. METHODS: Twenty patients with PD of short duration (time elapsed since first symptom +/- SD: 6.8 +/- 1.0 years) with mild to moderate motor signs (Unified Parkinson's Disease Rating Scale III "off" medication: 29 +/- 12) who responded well to levodopa treatment were included in pairs, matched for age, duration and severity of disease, and impairment in socioprofessional functioning. Patients were prospectively randomized to undergo bilateral subthalamic nucleus stimulation (n = 10) or receive optimized medical treatment (n = 10). Parkinsonian motor scores, quality of life, cognition, and psychiatric morbidity were assessed at inclusion and at 6, 12, and 18 months after randomization. RESULTS: Quality of life was improved by 24% in surgical and 0% in nonsurgical patients (p < 0.05). After 18 months, the severity of parkinsonian motor signs "off" medication, levodopa-induced motor complications, and daily levodopa dose were reduced by 69%, 83%, and 57% in operated patients and increased by 29%, 15%, and 12% in the group with medical treatment only (p < 0.001). Adverse events were mild or transient, and overall psychiatric morbidity and anxiety improved in the surgical group. CONCLUSIONS: Subthalamic nucleus stimulation should be considered a therapeutic option early in the course of Parkinson disease.

PMID: 17151341 [PubMed - as supplied by publisher]