How effective is subthalamic nucleus (STN) stimulation and globus pallidus interna (GPi) deep brain stimulation (DBS) in the management of Parkinson disease (PD)?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Recent landmark studies have demonstrated the effectiveness of STN and GPi DBS for appropriate Parkinson disease patients. [78] In a randomized, controlled trial of 255 patients enrolled in the Veterans Affairs (VA) Cooperative Studies Program (CSP) trial for patients with advanced Parkinson disease, bilateral DBS (STN and GPi) was more effective than best medical therapy in improving on time without troublesome dyskinesia, motor function, and quality of life at 6 months; however, DBS was associated with an increased risk of serious adverse events. [79] In the same study, when the 2-year outcomes of 147 patients who received STN DBS and 152 patients who received GPi DBS were compared, motor function and adverse events were not significantly different between the 2 sites. [80] However, those who received STN DBS had a greater reduction in dopaminergic medications, and individuals who received GPi DBS had significantly less depression. [80]

Investigators from the EARLYSTIM Study Group reported that relative to medical therapy alone, STN DBS in conjunction with medical therapy offers benefits earlier in the course of PD, before the appearance of severe disabling motor complications. [81, 82] Moreover, subthalamic stimulation plus medical therapy was superior to medical therapy alone on several key measures of quality of life and motor function. However, 54.8% of the patients in the DBS group suffered serious adverse events, compared to 44.1% of those in the medical-therapy group [81, 82] ; 17.7% of patients suffered serious adverse events related to surgical implantation or the neurostimulation device.


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