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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 68, Number 4, January 23, 2007 All Versions of this Article: 01.wnl.0000250253.03919.fbv1 68/4/267    most recent Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schüpbach, W.M.M. Articles by Agid, Y. Search for Related Content PubMed PubMed Citation Articles by Schüpbach, W.M.M. Articles by Agid, Y.

Neurosurgery at an earlier stage of Parkinson disease

A randomized, controlled trial

From the Centre d'Investigation Clinique (Y.A., C.B., A.M.B., V.C., M.G., J.L.H., L.M., D.M., W.M.M.S., M.L.W.), Fédération de Neurologie and National Institute of Health and Medical Research (INSERM) Unit 679, Service de Neuroradiologie (D.D.), Service des Explorations Fonctionnelles Neurologiques (B.P.), Service de Neurochirurgie (P.C., S.N.), Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Department of Biostatistics and Medical Information (S.T.d.M.,), Pitié-Salpêtrière Medical University, Paris, France; Centre Hospitalier (J.L.H.), Poitiers, France; and Centre Hospitalier (D.M.), Rouen, France.

Address correspondence and reprint requests to Dr. Y. Agid, Centre d'Investigation Clinique, Hôpital de la Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France; e-mail: secretaires.cic{at}psl.ap-hop-paris.fr

Background: Stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson disease (PD) and is currently performed after a mean disease duration of 14 years, when severe motor complications have resulted in marked loss of quality of life. We examined whether surgery at an early stage would maintain quality of life as well as improve motor function.

Methods: Twenty patients with PD of short duration (time elapsed since first symptom ± SD: 6.8 ± 1.0 years) with mild to moderate motor signs (Unified Parkinson's Disease Rating Scale III "off" medication: 29 ± 12) who responded well to levodopa treatment were included in pairs, matched for age, duration and severity of disease, and impairment in socioprofessional functioning. Patients were prospectively randomized to undergo bilateral subthalamic nucleus stimulation (n = 10) or receive optimized medical treatment (n = 10). Parkinsonian motor scores, quality of life, cognition, and psychiatric morbidity were assessed at inclusion and at 6, 12, and 18 months after randomization.

Results: Quality of life was improved by 24% in surgical and 0% in nonsurgical patients (p < 0.05). After 18 months, the severity of parkinsonian motor signs "off" medication, levodopa-induced motor complications, and daily levodopa dose were reduced by 69%, 83%, and 57% in operated patients and increased by 29%, 15%, and 12% in the group with medical treatment only (p < 0.001). Adverse events were mild or transient, and overall psychiatric morbidity and anxiety improved in the surgical group.

Conclusions: Subthalamic nucleus stimulation should be considered a therapeutic option early in the course of Parkinson disease.

Editorial, see page 252

This article was previously published in electronic format as an Expedited E-pub on December 6, 2006, at www.neurology.org.

*These authors contributed equally to the study.

Dr. Schüpbach was supported by grants from the Swiss National Science Foundation and the Swiss PD Association. The study was supported by Medtronic Europe.

Disclosure: Medtronic sponsored the study and provided the stimulators. However, Medtronic had no influence on decisions concerning the study design; on the enrollment of patients; on the collection, analysis, and interpretation of data; on the writing of the report; and on the decision to submit the paper for publication.

Received February 2, 2006. Accepted in final form September 22, 2006.

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