Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease
N Engl J Med. 2010 Jun 3;362(22):2077-91
Deep brain stimulation of either the globus pallidus interna (GPi) or subthalamic nucleus (STN) is a viable alternative to non-surgical treatment options for patients with advanced Parkinson’s disease. Here, the authors compared the change in motor function (primary outcome), as assessed by the unified Parkinson’s disease rating scale part III, following stimulation of either the GPi (152 patients) or STN (147 patients) for 24 months. In addition, secondary outcomes including self-reported function, quality of life, cognitive function and adverse effects were also assessed. The mean changes in primary outcome were no different between the two study groups, and there were also no differences in self-reported function. Patients undergoing STN stimulation required a lower dose of dopaminergic agents than those undergoing GPi stimulation, but visuomotor function declined more after STN stimulation than GPi stimulation. In addition, whilst depression improved in patients undergoing GPi stimulation, it worsened in patients undergoing STN stimulation. No significant differences in the incidence of serious adverse events were observed between study groups. The authors conclude that both STN and GPi stimulation improve motor function to a similar degree, but that non-motor factors must be considered when selecting the target for deep brain stimulation
Deep brain stimulation of either the globus pallidus interna (GPi) or subthalamic nucleus (STN) is a viable alternative to non-surgical treatment options for patients with advanced Parkinson’s disease. Here, the authors compared the change in motor function (primary outcome), as assessed by the unified Parkinson’s disease rating scale part III, following stimulation of either the GPi (152 patients) or STN (147 patients) for 24 months. In addition, secondary outcomes including self-reported function, quality of life, cognitive function and adverse effects were also assessed. The mean changes in primary outcome were no different between the two study groups, and there were also no differences in self-reported function. Patients undergoing STN stimulation required a lower dose of dopaminergic agents than those undergoing GPi stimulation, but visuomotor function declined more after STN stimulation than GPi stimulation. In addition, whilst depression improved in patients undergoing GPi stimulation, it worsened in patients undergoing STN stimulation. No significant differences in the incidence of serious adverse events were observed between study groups. The authors conclude that both STN and GPi stimulation improve motor function to a similar degree, but that non-motor factors must be considered when selecting the target for deep brain stimulation.
