title: A randomized trial of deep-brain stimulation for Parkinson's disease.
abstract: BACKGROUND
  Neurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson's disease. We compared this treatment plus medication with medical management.
  
  
  METHODS
  In this randomized-pairs trial, we enrolled 156 patients with advanced Parkinson's disease and severe motor symptoms. The primary end points were the changes from baseline to six months in the quality of life, as assessed by the Parkinson's Disease Questionnaire (PDQ-39), and the severity of symptoms without medication, according to the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III).
  
  
  RESULTS
  Pairwise comparisons showed that neurostimulation, as compared with medication alone, caused greater improvements from baseline to six months in the PDQ-39 (50 of 78 pairs, P=0.02) and the UPDRS-III (55 of 78, P<0.001), with mean improvements of 9.5 and 19.6 points, respectively. Neurostimulation resulted in improvements of 24 to 38 percent in the PDQ-39 subscales for mobility, activities of daily living, emotional well-being, stigma, and bodily discomfort. Serious adverse events were more common with neurostimulation than with medication alone (13 percent vs. 4 percent, P<0.04) and included a fatal intracerebral hemorrhage. The overall frequency of adverse events was higher in the medication group (64 percent vs. 50 percent, P=0.08).
  
  
  CONCLUSIONS
  In this six-month study of patients under 75 years of age with severe motor complications of Parkinson's disease, neurostimulation of the subthalamic nucleus was more effective than medical management alone. (ClinicalTrials.gov number, NCT00196911 [ClinicalTrials.gov].).
authors.affiliation: Christian Albrechts University, Kiel, Germany. g.deuschl@neurologie.uni-kiel.de
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.forename: Carmen
authors.initials: C
authors.lastname: Schade-Brittinger
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.forename: Helmut
authors.initials: H
authors.lastname: Schäfer
authors.forename: Kai
authors.initials: K
authors.lastname: Bötzel
authors.forename: Christine
authors.initials: C
authors.lastname: Daniels
authors.forename: Angela
authors.initials: A
authors.lastname: Deutschländer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Dillmann
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Eisner
authors.forename: Doreen
authors.initials: D
authors.lastname: Gruber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hamel
authors.forename: Jan
authors.initials: J
authors.lastname: Herzog
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hilker
authors.forename: Stephan
authors.initials: S
authors.lastname: Klebe
authors.forename: Manja
authors.initials: M
authors.lastname: Kloss
authors.forename: Jan
authors.initials: J
authors.lastname: Koy
authors.forename: Martin
authors.initials: M
authors.lastname: Krause
authors.forename: Andreas
authors.initials: A
authors.lastname: Kupsch
authors.forename: Delia
authors.initials: D
authors.lastname: Lorenz
authors.forename: Stefan
authors.initials: S
authors.lastname: Lorenzl
authors.forename: H Maximilian
authors.initials: HM
authors.lastname: Mehdorn
authors.forename: Jean Richard
authors.initials: JR
authors.lastname: Moringlane
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Oertel
authors.forename: Marcus O
authors.initials: MO
authors.lastname: Pinsker
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Reuss
authors.forename: Gerd-Helge
authors.initials: GH
authors.lastname: Schneider
authors.forename: Alfons
authors.initials: A
authors.lastname: Schnitzler
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steude
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
authors.forename: Volker
authors.initials: V
authors.lastname: Tronnier
authors.forename: Thomas
authors.initials: T
authors.lastname: Trottenberg
authors.forename: Lars
authors.initials: L
authors.lastname: Wojtecki
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wolf
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Jürgen
authors.initials: J
authors.lastname: Voges
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000009:adverse effects; D020820:Dyskinesias / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents