Progression and survival in Parkinson's disease with subthalamic nucleus stimulation.
BACKGROUND
Treatment for Parkinson's disease (PD) is symptomatic. Surgical treatment with continuous high-frequency stimulation of the subthalamic nucleus (STN-DBS) is established as a safe symptomatic treatment with long-term beneficial effects. It has been postulated that STN-DBS could halt the progression of PD through a disease modifying or neuroprotective effect.


OBJECTIVE
To investigate the postulated disease modifying or neuroprotective effect of STN-DBS by comparing the rate of deterioration of parkinsonism and mortality over time in two selected and matched groups of patients with PD with and without surgery.


METHODS
Group A was derived from all patients who received STN-DSB surgery at Oslo University Hospital, from January 2001 to December 2007. Group B was derived from a prevalence study of PD in the Stavanger area of Western Norway in 1993. The two groups were individually matched and the disease progression measured by Unified Parkinson's Disease Rating Scale-motor scores, and the mortality was compared.


RESULTS
The mean annual change based on baseline and last observation scores in individually matched groups was 0.97 (SD = 3.57) for the surgery group and 1.04 (SD = 3.33) for the controls and thus not significantly different, F(1, 104) = .21, P = 0.89. The long-term mortality was also similar in the two groups during long-term follow-up, hazard ratio = 1.76, CL 0.91-3.40, P = 0.091.


CONCLUSIONS
This study gives no support to a postulated disease modifying or neuroprotective effect of STN-DBS in patients with PD.
The Norwegian Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
B
B
Lilleeng
K
K
Brønnick
M
M
Toft
E
E
Dietrichs
J P
JP
Larsen
D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010300:Parkinson Disease / Q000401:mortality* / Q000628:therapy*; D016016:Proportional Hazards Models; D020531:Subthalamic Nucleus / Q000502:physiology
Parkinson's disease; deep brain stimulation of the subthalamic nucleus; modulation; mortality; progression