Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson's disease: one year follow-up of a randomised observer-blind multi centre trial.
BACKGROUND
To investigate whether STN stimulation is more efficacious than unilateral pallidotomy in advanced Parkinson's disease (PD) one year after surgery.


METHODS
Thirty-four patients with advanced PD were randomly assigned to unilateral pallidotomy or bilateral STN stimulation. Outcome measures were parkinsonian symptoms in off and on phases (UPDRS 3), dyskinesias, functional status, Parkinson's disease quality of life questionnaire, the effects on separate symptoms, timed tests, patient diaries, dopaminergic drugs changes, adverse effects, and global outcome scale. Patients were assessed before surgery, six months and one year after surgery. The primary outcome measure was the off phase UPDRS 3 at six months follow-up.


RESULTS
The off phase UPDRS 3 score improved from 46.5 to 32 points in the pallidotomy patients and from 51.5 to 24 in the STN stimulation patients (p = 0.002). On phase UPDRS 3 and off phase Schwab and England functional scale improved significantly in favour of the STN stimulation patients. Dopaminergic drugs reduction was larger in the STN group although the difference between the treatment groups was not significant. One patient in each group had a major adverse effect.


CONCLUSIONS
Bilateral STN stimulation is more efficacious than unilateral pallidotomy in advanced PD up to one year after surgery.
Esselink
R A J
RA
Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
de Bie
R M A
RM
de Haan
R J
RJ
Steur
E N H J
EN
Beute
G N
GN
Portman
A T
AT
Schuurman
P R
PR
Bosch
D A
DA
Speelman
J D
JD
D000203:Activities of Daily Living; D000368:Aged; D015259:Dopamine Agents / Q000627:therapeutic use; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D005917:Globus Pallidus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000601:surgery* / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011788:Quality of Life; D013238:Stereotaxic Techniques / Q000706:statistics & numerical data*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D015259:Dopamine Agents