title: Earlier versus later subthalamic deep brain stimulation in Parkinson's disease.
abstract: BACKGROUND
  Subthalamic nucleus deep brain stimulation (STN-DBS) has been recently compared to a possible "second therapeutic honeymoon" for Parkinson's disease, as it might prevent the development of severe motor complications and lessen the social adjustment associated to disease progression. This study aims to evaluate whether an early surgical treatment could result in better long-term outcomes, comparing the follow-up evolution of 203 parkinsonian patients, treated at different stages of the disease course.
  
  
  METHODS
  The retrospective allocation to Early- or Late-Stimulated groups was performed in accordance to disease severity at the time of surgery and motor fluctuations duration. Then, the two groups clinical outcomes were compared after more than 8 years of follow-up by means of the Unified Parkinson's Disease Rating Scale, reporting the overall disability experienced by patients during the entire observational period.
  
  
  RESULTS
  Subjects receiving an earlier STN-DBS showed a sustained improvement in the activities of daily living and motor complications, never reaching the severe levels of disability reported by Late-Stimulated patients at the time of surgical selection. After ≥8 years of follow-up the Early-Stimulated group still reported a 28.7% lower impairment in activities of daily living and 43.8% lower duration of waking day spent in OFF compared to their pre-surgical basal scores.
  
  
  CONCLUSIONS
  Although the limitation of a retrospective study design should be considered in the interpretation of data, our findings suggest that an earlier STN-DBS treatment might result in a more precocious stabilization of motor complications, with beneficial effects on the patient's social and professional life autonomy.
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy. Electronic address: aristidemerola@hotmail.com.
authors.forename: Aristide
authors.initials: A
authors.lastname: Merola
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Romagnolo
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bernardini
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Rizzi
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Artusi
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Lanotte
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Mario Giorgio
authors.initials: MG
authors.lastname: Rizzone
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zibetti
authors.affiliation: Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lopiano
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods* / Q000592:standards; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000601:surgery; D013997:Time Factors
keywords: Advanced; Complications; DBS; Early; Parkinson