title: Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial.
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.
authors.affiliation: Centre d'Investigation Clinique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: W M M
authors.initials: WM
authors.lastname: Schüpbach
authors.forename: D
authors.initials: D
authors.lastname: Maltête
authors.forename: J L
authors.initials: JL
authors.lastname: Houeto
authors.forename: S Tezenas
authors.initials: ST
authors.lastname: du Montcel
authors.forename: L
authors.initials: L
authors.lastname: Mallet
authors.forename: M L
authors.initials: ML
authors.lastname: Welter
authors.forename: M
authors.initials: M
authors.lastname: Gargiulo
authors.forename: C
authors.initials: C
authors.lastname: Béhar
authors.forename: A M
authors.initials: AM
authors.lastname: Bonnet
authors.forename: V
authors.initials: V
authors.lastname: Czernecki
authors.forename: B
authors.initials: B
authors.lastname: Pidoux
authors.forename: S
authors.initials: S
authors.lastname: Navarro
authors.forename: D
authors.initials: D
authors.lastname: Dormont
authors.forename: P
authors.initials: P
authors.lastname: Cornu
authors.forename: Y
authors.initials: Y
authors.lastname: Agid
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010300:Parkinson Disease / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D020531:Subthalamic Nucleus / Q000502:physiology; D013997:Time Factors
chemical_list: D000978:Antiparkinson Agents