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From the Departments of Neurology (Drs. Esselink, de Bie, and Speelman, and H.M.M. Smeding), Clinical Epidemiology and Biostatistics (Dr. de Haan), and Neurosurgery (Drs. Schuurman and Bosch), Academic Medical Center, Amsterdam; Department of Neurosurgery (Dr. Lenders), Medical Spectrum Twente, Enschede; Department of Neurology (Dr. Nijssen), St Elisabeth Hospital, Tilburg; and Department of Neurosurgery (Dr. Staal), Academic Hospital Groningen, the Netherlands.
Address correspondence and reprint requests to Dr. J.D. Speelman, Department of Neurology, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands; e-mail: J.D.Speelman{at}amc.uva.nl
Objective: To compare the efficacy of unilateral pallidotomy and bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson disease (PD) in a randomized, observer-blind, multicenter trial.
Methods: Thirty-four patients with advanced PD were randomly assigned to have unilateral pallidotomy or bilateral STN stimulation. The primary outcome was the change from baseline to 6 months in the motor part of the Unified PD Rating Scale (motor UPDRS) in the off phase. Secondary outcomes were parkinsonian symptoms in the on phase (motor UPDRS), dyskinesias (Clinical Dyskinesia Rating Scale and dyskinesias UPDRS), functional status (activities of daily living UPDRS and Schwab and England scale), PD Quality of Life questionnaire, changes in drug treatment, and adverse effects.
Results: The off phase motor UPDRS score improved from 46.5 to 37 points in the group of pallidotomy patients and from 51.5 to 26.5 in the STN stimulation patients (p = 0.002). Of the secondary outcome measures, on phase motor UPDRS and dyskinesias UPDRS improved significantly in favor of the STN stimulation patients. Reduction of antiparkinsonian drugs was greater after STN stimulation than after pallidotomy. One patient in each group had a major adverse effect.
Conclusions: Bilateral STN stimulation is more effective than unilateral pallidotomy in reducing parkinsonian symptoms in patients with advanced PD.
Received March 12, 2003. Accepted in final form September 8, 2003.
Dr. Esselink is currently affiliated with the University Medical Center, Nijmegen, the Netherlands.
J.D.S. acts as an independent consultant for Medtronic Ltd. (Minneapolis). An unrestricted research grant was received from Medtronic Ltd. for the workgroup Movement Disorders at the Academic Medical Center, University of Amsterdam. All authors received travel grants from Medtronic Ltd. to participate in scientific meetings, except for D.A.B. and R.J.H.
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