Neurostimulation earlier for selected adults with Parkinson’s diseaseBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1051 (Published 20 February 2013) Cite this as: BMJ 2013;346:f1051
Neurostimulation of the subthalamic nucleus is an established treatment for people with advanced Parkinson’s disease and severe motor complications such as dyskinesias. Doctors could consider treating people at an earlier stage, say researchers. In a randomised trial, neurostimulation worked significantly better than medical treatment alone in a selection of patients with early motor complications who were still young (mean age 52 years), relatively well, and responding well to levodopa⇑.
The 124 patients treated with neurostimulation in addition to medical treatment reported significantly greater improvements in quality of life than 127 controls given medical treatments alone (an extra 8 point improvement on a score running from 0 to 100, 95% CI 4.2 to 11.9; P=0.002). They had greater improvements in motor function and reported longer periods of good mobility without dyskinesia than controls. Serious adverse events were more common in the neurostimulation group (68 v 56 patients reporting at least one), however, and included one extra suicide (2 v 1). The trial lasted two years.
This rigorous European trial should serve as a model to others evaluating neurostimulation for Parkinson’s disease, says a linked editorial (p 675). But we should remember that few real world patients match those studied here. Only one in 10 patients is diagnosed before the age of 60 years, and close to a third already have dementia. Doctors should select patients carefully for earlier neurostimulation while researchers test early treatment in older populations.
Cite this as: BMJ 2013;346:f1051