Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease
- 25 March 2015
- journal article
- research article
- Published by Wiley in Annals of Neurology
- Vol. 77 (4), 710-719
- https://doi.org/10.1002/ana.24374
Abstract
Objective: The VA Cooperative Studies Program (CSP) #468, a multicenter study that randomized Parkinson's disease (PD) patients to either subthalamic nucleus (STN) or globus pallidus internus (GPi) deep brain stimulation (DBS), found that stimulation at either target provided similar overall motoric benefits. We conducted an additional analysis of this dataset to evaluate if PD motor subtypes responded differently to the two stimulation targets. Methods: We classified 235 subjects by motor subtype: Tremor Dominant (TD), Intermediate (I), or Postural Instability Gait Difficulty (PIGD), based on pre‐DBS baseline Unified Parkinson's Disease Rating Scale (UPDRS) scores, off‐medication. The primary outcome was change in UPDRS part III (UPDRS‐III) off‐medication scores from baseline to 24 months post‐DBS, compared among subjects with particular PD motor subtypes and by DBS target (STN vs. GPi). Changes in tremor, rigidity, akinesia, and gait scores were also assessed using the UPDRS. Results: TD patients had greater mean overall motor improvement, measured by UPDRS‐III, after GPi DBS, compared to STN DBS (17.5 ± 13.0 vs. 14.6 ± 14.9, p = 0.02), with improvement in gait accounting for this difference. Regardless of stimulation target, PIGD subjects had lower mean overall improvement in UPDRS‐III scores compared with I or TD subjects (8.7 ± 12.2 vs. 21.7 ± 11.2 vs. 16.3 ± 13.8, p=<0.001) Interpretation: Our results suggest that responsiveness to both GPi and STN DBS is similar among different PD motor subtypes, although the TD motor subtype may have a greater response to GPi DBS with respect to gait. PIGD patients obtained less overall benefit from stimulation.Keywords
Funding Information
- Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development
- NIH National Institute of Neurological Disorders and Stroke, and Medtronic
This publication has 36 references indexed in Scilit:
- Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trialThe Lancet Neurology, 2010
- Subthalamic nucleus deep brain stimulation: Summary and meta-analysis of outcomesMovement Disorders, 2006
- Deep brain stimulation in Parkinson disease: a metaanalysis of patient outcomesJournal of Neurosurgery, 2005
- Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-upBrain, 2005
- Subthalamic Nucleus vs Globus Pallidus Interna Deep Brain Stimulation, the RematchArchives of Neurology, 2005
- Long‐term results of bilateral pallidal stimulation in Parkinson's diseaseAnnals of Neurology, 2004
- Deep brain stimulation for the treatment of Parkinson's disease: subthalamic nucleus versus globus pallidus internusJournal of Neurology, Neurosurgery & Psychiatry, 2001
- Electrical inhibition of basal ganglia nuclei in Parkinson's disease: long-term results.Stereotactic and Functional Neurosurgery, 1999
- Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's diseaseBrain, 1998
- Effect on parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulationThe Lancet, 1995