title: GPi vs STN deep brain stimulation for Parkinson disease: Three-year follow-up.
abstract: OBJECTIVE
  To compare motor symptoms, cognition, mood, and behavior 3 years after deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and subthalamic nucleus (STN) in advanced Parkinson disease (PD).
  
  
  METHODS
  Patients with PD eligible for DBS were randomized to bilateral GPi DBS and bilateral STN DBS (1:1). The primary outcome measures were (1) improvement in motor symptoms in off-drug phase measured with the Unified Parkinson Disease Rating Scale (UPDRS) and (2) a composite score for cognitive, mood, and behavioral effects, and inability to complete follow-up at 36 months after surgery.
  
  
  RESULTS
  Of the 128 patients enrolled, 90 were able to complete the 3-year follow-up. We found significantly more improvement of motor symptoms after STN DBS (median [interquartile range (IQR)] at 3 years, GPi 33 [23-41], STN 28 [20-36], p = 0.04). No between-group differences were observed on the composite score (GPi 83%, STN 86%). Secondary outcomes showed larger improvement in off-drug functioning in the AMC Linear Disability Scale score after STN DBS (mean ± SD, GPi 65.2 ± 20.1, STN 72.6 ± 18.0, p = 0.05). Medication was reduced more after STN DBS (median levodopa equivalent dose [IQR] at 3 years, GPi 1,060 [657-1,860], STN 605 [411-875], p < 0.001). No differences in adverse effects were recorded, apart from more reoperations to a different target after GPi DBS (GPi n = 8, STN n = 1).
  
  
  CONCLUSIONS
  Off-drug phase motor symptoms and functioning improve more after STN DBS than after GPi DBS. No between-group differences were observed on a composite score for cognition, mood, and behavior, and the inability to participate in follow-up.
  
  
  METHODS
  This study provides Class II evidence that STN DBS provides more off-phase motor improvement than GPi DBS, but with a similar risk for cognitive, mood, and behavioral complications.
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands. v.j.odekerken@amc.uva.nl.
authors.forename: Vincent J J
authors.initials: VJ
authors.lastname: Odekerken
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Boel
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
authors.forename: Ben A
authors.initials: BA
authors.lastname: Schmand
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: de Haan
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Figee
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
authors.forename: Pepijn
authors.initials: P
authors.lastname: van den Munckhof
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
authors.forename: P Richard
authors.initials: PR
authors.lastname: Schuurman
authors.affiliation: From the Department of Neurology (V.J.J.O., J.A.B., R.M.A.d.B.), Department of Medical Psychology (B.A.S.), Clinical Research Unit (R.J.d.H.), Department of Psychiatry (M.F.), and Department of Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, Amsterdam; and Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
authors.forename: Rob M A
authors.initials: RM
authors.lastname: de Bie
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010300:Parkinson Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000502:physiology; D016896:Treatment Outcome