title: Medical therapy and subthalamic deep brain stimulation in advanced Parkinson's disease: a different long-term outcome?
abstract: OBJECTIVE
  Few clinical trials reported the comparative short-term efficacy of subthalamic nucleus deep brain stimulation (STN-DBS) versus medical therapy in advanced Parkinson's disease (PD). However, the comparative efficacy, safety and the potential disease-modifying effect of these treatments have not been investigated over a longer follow-up period.
  
  
  METHODS
  In this study, we organised a 'retrospective control group' to compare medical and surgical therapies over a long-term period. We assessed a group of PD patients suitable for STN-DBS but successively treated with medical therapies for reasons not related to PD, and a group of similar consecutive STN-DBS patients. We thus obtained two groups comparable at baseline, which were re-evaluated after an average follow-up of 6 years (range 4-11).
  
  
  RESULTS
  Patients treated with STN-DBS showed a long-lasting superior clinical efficacy on motor fluctuations, with a significant reduction in the average percentage of the waking day spent in 'OFF' and in the duration and disability of dyskinesia. Moreover, operated patients showed a better outcome in the activities of daily living in 'Medication-OFF' condition. On the other hand, a similar progression of motor score and cognitive/behavioural alterations was observed between the two groups, apart from phonemic verbal fluency, which significantly worsened in STN-DBS patients.
  
  
  CONCLUSIONS
  To our knowledge, this is the first long-term comparison between medical and surgical therapies; a superior efficacy of STN-DBS was observed on motor disability, while no significant differences were observed in the progression of motor symptoms and, apart from phonemic verbal fluency, of neuropsychological alterations.
authors.affiliation: Department of Neuroscience, University of Torino, , Turin, Italy.
authors.forename: Aristide
authors.initials: A
authors.lastname: Merola
authors.forename: Laura
authors.initials: L
authors.lastname: Rizzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zibetti
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Artusi
authors.forename: Elisa
authors.initials: E
authors.lastname: Montanaro
authors.forename: Serena
authors.initials: S
authors.lastname: Angrisano
authors.forename: Michele
authors.initials: M
authors.lastname: Lanotte
authors.forename: Mario Giorgio
authors.initials: MG
authors.lastname: Rizzone
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lopiano
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D020531:Subthalamic Nucleus; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Electrical Stimulation; Interventional; Movement Disorders; Parkinson'S Disease