title: Advanced therapies in Parkinson's disease: Long-term retrospective study.
abstract: Levodopa/carbidopa intestinal gel infusion (LCIG) and subthalamic nucleus deep brain stimulation (STN-DBS) are approved therapies for advanced Parkinson's disease (PD) whose long-term comparability remains unclear.
  
  
  
  We reviewed the 5-year data on activities of daily living (ADL) and motor complications (OFF time, dyskinesia duration, and dyskinesia severity), as measured by the Unified Parkinson Disease Rating Scale (UPDRS) section-II and section-IV (items 39, 32, and 33, respectively) in 60 PD patients exposed to STN-DBS (n = 20), LCIG (n = 20), and oral medical therapy (OMT) (n = 20) at similar baseline disability and cognitive state.
  
  
  
  STN-DBS and LCIG showed a similar magnitude of deterioration in ADL (+6.1 vs. +5.7 UPDRS-II; p = 0.709), but lesser than with OMT (+13.7 UPDRS-II; p = 0.005). OFF time also improved to the same extent in STN-DBS and LCIG (-62% vs. -54.5%; p = 0.830), while worsened with OMT (+78.6%; p < 0.001). STN-DBS and LCIG yielded greater improvement on dyskinesia compared to OMT (dyskinesia duration: -66.1% vs. -9.0% vs. +24.2% [p = 0.001]; dyskinesia severity: -68.8% vs. -18.0% vs. +16.2% [p = 0.002]), with relative superiority of STN-DBS over LCIG (p = 0.004 for duration; p = 0.014 for severity). The annualized rate of complication was lower in STN-DBS vs. LCIG (0.13 vs. 0.68; p < 0.001) but not different between STN-DBS and OMT (0.13 vs. 0.10; p = 0.795).
  
  
  
  STN-DBS and LCIG showed comparable efficacy in ADL and OFF time, superior to OMT. STN-DBS yielded greater improvement in dyskinesia and lower long-term rate of complications than LCIG.
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy. Electronic address: aristidemerola@hotmail.com.
authors.forename: Aristide
authors.initials: A
authors.lastname: Merola
authors.affiliation: Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Romagnolo
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bernardini
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Rizzi
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Rosso
authors.affiliation: Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Kristy J
authors.initials: KJ
authors.lastname: Espay
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zibetti
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Lanotte
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lopiano
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D002230:Carbidopa / Q000627:therapeutic use*; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000379:methods*; D004338:Drug Combinations; D005260:Female; D005782:Gels / Q000627:therapeutic use; D006801:Humans; D007422:Intestines / Q000187:drug effects / Q000502:physiology; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012720:Severity of Illness Index; D013788:Thalamus / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D004338:Drug Combinations; D005782:Gels; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa
keywords: Electrical stimulation; Movement disorders; Neuropharmacology; Neurosurgery; Parkinson’s disease