• Günther Deuschl, Carmen Schade-Brittinger, Paul Krack, Jens Volkmann, Helmut Schäfer, Kai Bötzel, Christine Daniels, Angela Deutschländer, Ulrich Dillmann, Wilhelm Eisner, Doreen Gruber, Wolfgang Hamel, Jan Herzog, Rüdiger Hilker, Stephan Klebe, Manja Kloss, Jan Koy, Martin Krause, Andreas Kupsch, Delia Lorenz, Stefan Lorenzl, H Maximilian Mehdorn, Jean Richard Moringlane, Wolfgang Oertel, Marcus O Pinsker, Heinz Reichmann, Alexander Reuss, Gerd-Helge Schneider, Alfons Schnitzler, Ulrich Steude, Volker Sturm, Lars Timmermann, Volker Tronnier, Thomas Trottenberg, Lars Wojtecki, Elisabeth Wolf, Werner Poewe, Jürgen Voges, and German Parkinson Study Group, Neurostimulation Section.
• Christian Albrechts University, Kiel, Germany. g.deuschl@neurologie.uni-kiel.de
• N. Engl. J. Med. 2006 Aug 31;355(9):896-908.

BackgroundNeurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson's disease. We compared this treatment plus medication with medical management.MethodsIn this randomized-pairs trial, we enrolled 156 patients with advanced Parkinson's disease and severe motor symptoms. The primary end points were the changes from baseline to six months in the quality of life, as assessed by the Parkinson's Disease Questionnaire (PDQ-39), and the severity of symptoms without medication, according to the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III).ResultsPairwise comparisons showed that neurostimulation, as compared with medication alone, caused greater improvements from baseline to six months in the PDQ-39 (50 of 78 pairs, P=0.02) and the UPDRS-III (55 of 78, P<0.001), with mean improvements of 9.5 and 19.6 points, respectively. Neurostimulation resulted in improvements of 24 to 38 percent in the PDQ-39 subscales for mobility, activities of daily living, emotional well-being, stigma, and bodily discomfort. Serious adverse events were more common with neurostimulation than with medication alone (13 percent vs. 4 percent, P<0.04) and included a fatal intracerebral hemorrhage. The overall frequency of adverse events was higher in the medication group (64 percent vs. 50 percent, P=0.08).ConclusionsIn this six-month study of patients under 75 years of age with severe motor complications of Parkinson's disease, neurostimulation of the subthalamic nucleus was more effective than medical management alone. (ClinicalTrials.gov number, NCT00196911 [ClinicalTrials.gov].).Copyright 2006 Massachusetts Medical Society.

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