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Related Experiment Videos

Comparing two randomized deep brain stimulation trials for Parkinson's disease.

Günther Deuschl1, Kenneth A Follett2,3, Ping Luo4

  • 11Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts-University Kiel, Germany.

Journal of Neurosurgery
|April 6, 2019
PubMed
Summary

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Patient selection, particularly levodopa responsiveness, significantly impacts deep brain stimulation (DBS) outcomes for Parkinson's disease. Preoperative levodopa responsiveness (LDR) is key to understanding differences in motor function and quality of life improvements after DBS.

Area of Science:

  • Neurology
  • Neurosurgery
  • Medical Technology

Background:

  • Deep brain stimulation (DBS) of the subthalamic nucleus is a treatment option for Parkinson's disease.
  • Randomized studies have compared DBS with medical management, but outcome measures vary.
  • Two major studies, the German LQ study and the US VA/NINDS trial, provide data for comparison.

Purpose of the Study:

  • To compare outcomes between the LQ study and the VA/NINDS trial for subthalamic nucleus DBS in Parkinson's disease.
  • To identify factors contributing to differences in reported outcomes between these two large studies.

Main Methods:

  • Analysis of "as-treated completers" from both studies (LQ: 69 patients, VA/NINDS: 125 patients).
  • Utilized 6-month follow-up data for comparison.
Keywords:
Parkinson’s diseasedeep brain stimulationfunctional neurosurgeryoutcomes

Related Experiment Videos

  • Data analyzed using SAS software by biostatisticians from involved institutions and Medtronic.

    • Main Results:

    • Pre-DBS demographics differed, with higher levodopa responsiveness (LDR) in the LQ study.
    • LQ subjects showed greater improvements in motor function (UPDRS-III) and activities of daily living (ADLs) post-DBS.
    • No significant differences in medication reduction or non-ADL quality of life improvements were observed.
    • When stratified by LDR, "full responders" showed similar motor improvements with DBS in both studies.

    Conclusions:

    • Patient selection criteria, especially preoperative levodopa responsiveness (LDR), are critical determinants of motor and quality of life outcomes in DBS for Parkinson's disease.
    • Differences in LDR between study populations likely explain the observed outcome variations.