PMID- 20519680 OWN - NLM STAT- MEDLINE DCOM- 20100611 LR - 20220410 IS - 1533-4406 (Electronic) IS - 0028-4793 (Linking) VI - 362 IP - 22 DP - 2010 Jun 3 TI - Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. PG - 2077-91 LID - 10.1056/NEJMoa0907083 [doi] AB - BACKGROUND: Deep-brain stimulation is the surgical procedure of choice for patients with advanced Parkinson's disease. The globus pallidus interna and the subthalamic nucleus are accepted targets for this procedure. We compared 24-month outcomes for patients who had undergone bilateral stimulation of the globus pallidus interna (pallidal stimulation) or subthalamic nucleus (subthalamic stimulation). METHODS: At seven Veterans Affairs and six university hospitals, we randomly assigned 299 patients with idiopathic Parkinson's disease to undergo either pallidal stimulation (152 patients) or subthalamic stimulation (147 patients). The primary outcome was the change in motor function, as blindly assessed on the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III), while patients were receiving stimulation but not receiving antiparkinsonian medication. Secondary outcomes included self-reported function, quality of life, neurocognitive function, and adverse events. RESULTS: Mean changes in the primary outcome did not differ significantly between the two study groups (P=0.50). There was also no significant difference in self-reported function. Patients undergoing subthalamic stimulation required a lower dose of dopaminergic agents than did those undergoing pallidal stimulation (P=0.02). One component of processing speed (visuomotor) declined more after subthalamic stimulation than after pallidal stimulation (P=0.03). The level of depression worsened after subthalamic stimulation and improved after pallidal stimulation (P=0.02). Serious adverse events occurred in 51% of patients undergoing pallidal stimulation and in 56% of those undergoing subthalamic stimulation, with no significant between-group differences at 24 months. CONCLUSIONS: Patients with Parkinson's disease had similar improvement in motor function after either pallidal or subthalamic stimulation. Nonmotor factors may reasonably be included in the selection of surgical target for deep-brain stimulation. (ClinicalTrials.gov numbers, NCT00056563 and NCT01076452.) CI - 2010 Massachusetts Medical Society FAU - Follett, Kenneth A AU - Follett KA AD - Iowa City Veterans Affairs Medical Center, Iowa City, USA. FAU - Weaver, Frances M AU - Weaver FM FAU - Stern, Matthew AU - Stern M FAU - Hur, Kwan AU - Hur K FAU - Harris, Crystal L AU - Harris CL FAU - Luo, Ping AU - Luo P FAU - Marks, William J Jr AU - Marks WJ Jr FAU - Rothlind, Johannes AU - Rothlind J FAU - Sagher, Oren AU - Sagher O FAU - Moy, Claudia AU - Moy C FAU - Pahwa, Rajesh AU - Pahwa R FAU - Burchiel, Kim AU - Burchiel K FAU - Hogarth, Penelope AU - Hogarth P FAU - Lai, Eugene C AU - Lai EC FAU - Duda, John E AU - Duda JE FAU - Holloway, Kathryn AU - Holloway K FAU - Samii, Ali AU - Samii A FAU - Horn, Stacy AU - Horn S FAU - Bronstein, Jeff M AU - Bronstein JM FAU - Stoner, Gatana AU - Stoner G FAU - Starr, Philip A AU - Starr PA FAU - Simpson, Richard AU - Simpson R FAU - Baltuch, Gordon AU - Baltuch G FAU - De Salles, Antonio AU - De Salles A FAU - Huang, Grant D AU - Huang GD FAU - Reda, Domenic J AU - Reda DJ CN - CSP 468 Study Group LA - eng SI - ClinicalTrials.gov/NCT00056563 SI - ClinicalTrials.gov/NCT01076452 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - IM CIN - J Neurol. 2010 Aug;257(8):1411-4. PMID: 20652299 CIN - N Engl J Med. 2010 Sep 2;363(10):987; author reply 988. PMID: 20809850 CIN - N Engl J Med. 2010 Sep 2;363(10):987-8; author reply 988. PMID: 20830819 MH - Activities of Daily Living MH - Aged MH - Cognition MH - Electric Stimulation Therapy/adverse effects/*methods/mortality MH - Female MH - Follow-Up Studies MH - *Globus Pallidus MH - Humans MH - Intention to Treat Analysis MH - Male MH - Middle Aged MH - *Motor Skills MH - Parkinson Disease/mortality/physiopathology/*therapy MH - Quality of Life MH - *Subthalamic Nucleus MH - Treatment Outcome FIR - Follett, Kenneth IR - Follett K FIR - Stern, Matthew IR - Stern M FIR - Weaver, Frances IR - Weaver F FIR - Ippolito, Dolores IR - Ippolito D FIR - Stoner, Gatana IR - Stoner G FIR - Barnett, Tammy IR - Barnett T FIR - Bukowski, Ken IR - Bukowski K FIR - DeNicolo, Rosemarie IR - DeNicolo R FIR - Hur, Kwan IR - Hur K FIR - Jimenez, Joyce IR - Jimenez J FIR - Luo, Ping IR - Luo P FIR - Motyka, Jan IR - Motyka J FIR - Reda, Domenic IR - Reda D FIR - Simon, Theresa IR - Simon T FIR - Thakkar, Bharat IR - Thakkar B FIR - Woolson, Robert IR - Woolson R FIR - Fye, Carol IR - Fye C FIR - Gagne, William IR - Gagne W FIR - Harris, Crystal IR - Harris C FIR - Heemskerk, Jill IR - Heemskerk J FIR - Moy, Claudia IR - Moy C FIR - Sheehy, Paul IR - Sheehy P FIR - O'Leary, Timothy IR - O'Leary T FIR - Huang, Grant D IR - Huang GD FIR - Fiore, Louis IR - Fiore L FIR - Hall, Robert IR - Hall R FIR - Stroupe, Kevin IR - Stroupe K FIR - Burchiel, Kim IR - Burchiel K FIR - Follett, Kenneth IR - Follett K FIR - Fye, Carol IR - Fye C FIR - Harris, Crystal IR - Harris C FIR - Heemskerk, Jill IR - Heemskerk J FIR - Hur, Kwan IR - Hur K FIR - Koller, William IR - Koller W FIR - Marks, William J Jr IR - Marks WJ Jr FIR - Moy, Claudia IR - Moy C FIR - Pahwa, Rajesh IR - Pahwa R FIR - Reda, Domenic IR - Reda D FIR - Rothlind, Johannes IR - Rothlind J FIR - Sagher, Oren IR - Sagher O FIR - Sheehy, Paul IR - Sheehy P FIR - Stern, Matthew IR - Stern M FIR - Weaver, Frances IR - Weaver F FIR - Bakay, Roy IR - Bakay R FIR - Chappell, Rick IR - Chappell R FIR - Hart, Robert IR - Hart R FIR - Holloway, Robert Jr IR - Holloway R Jr FIR - McCabe, George IR - McCabe G FIR - Schenkman, Margaret IR - Schenkman M FIR - Taha, Jamal IR - Taha J FIR - Buckelew, Julia IR - Buckelew J FIR - Fye, Carol IR - Fye C FIR - Garin, Marilyn IR - Garin M FIR - Matzek, Sharon IR - Matzek S FIR - Smith, Donna IR - Smith D FIR - Bronstein, Jeff IR - Bronstein J FIR - Duda, John IR - Duda J FIR - Hogarth, Penelope IR - Hogarth P FIR - Holloway, Kathryn IR - Holloway K FIR - Horn, Stacy IR - Horn S FIR - Lai, Eugene C IR - Lai EC FIR - Marks, William J Jr IR - Marks WJ Jr FIR - Samii, Ali IR - Samii A FIR - Atassi, Farah IR - Atassi F FIR - Bello, Cecilia IR - Bello C FIR - Bunting-Perry, Lisette IR - Bunting-Perry L FIR - Conn, Tina IR - Conn T FIR - Cugley, Alice IR - Cugley A FIR - Eubank, Nanette IR - Eubank N FIR - Fincher, Linda IR - Fincher L FIR - Franks, Romay IR - Franks R FIR - Harris, Tammy IR - Harris T FIR - Haselman, Mariann IR - Haselman M FIR - Heath, Susan IR - Heath S FIR - Hirsch, Miriam IR - Hirsch M FIR - Janovsky, Virginia IR - Janovsky V FIR - Lanier, Elaine IR - Lanier E FIR - Lloyd, Mary IR - Lloyd M FIR - Loehner, Susan IR - Loehner S FIR - O'Connor, Susan IR - O'Connor S FIR - Ordonez, Ligaya IR - Ordonez L FIR - Maccarone, Heather IR - Maccarone H FIR - Massey-Makhoul, Kelli IR - Massey-Makhoul K FIR - Matthews, Mary IR - Matthews M FIR - Meyn, Elizabeth IR - Meyn E FIR - Mimura, Keiko IR - Mimura K FIR - Morrow, Wes IR - Morrow W FIR - Searles, Tammy IR - Searles T FIR - Valotta, Jamye IR - Valotta J FIR - Vasthare, Usha IR - Vasthare U FIR - Volz, Monica IR - Volz M FIR - Ward, Constance IR - Ward C FIR - Warker, Rebecca IR - Warker R FIR - Watson, Heidi IR - Watson H FIR - Willson, Pamela IR - Willson P FIR - Baron, Mark IR - Baron M FIR - Calabrese, Vincent IR - Calabrese V FIR - Colcher, Amy IR - Colcher A FIR - Farag, Emad IR - Farag E FIR - Henry, Eva IR - Henry E FIR - Hou, Jyh-Gong IR - Hou JG FIR - Kang, Gail IR - Kang G FIR - Kleiner-Fisman, Galit IR - Kleiner-Fisman G FIR - Nutt, John IR - Nutt J FIR - Ostrem, Jill IR - Ostrem J FIR - Sarwar, Aliya IR - Sarwar A FIR - Subramanian, Indu IR - Subramanian I FIR - Vanek, Zeba IR - Vanek Z FIR - Baltuch, Gordon IR - Baltuch G FIR - Burchiel, Kim IR - Burchiel K FIR - De Salles, Antonio IR - De Salles A FIR - Eller, Jorge IR - Eller J FIR - Holloway, Kathryn IR - Holloway K FIR - Larson, Paul IR - Larson P FIR - Simpson, Richard IR - Simpson R FIR - Starr, Philip IR - Starr P FIR - Carne, William IR - Carne W FIR - Erikson, Tom IR - Erikson T FIR - Jaggi, Jurg IR - Jaggi J FIR - Kreutzer, Jeffrey IR - Kreutzer J FIR - Mendez, Mario IR - Mendez M FIR - Moberg, Paul IR - Moberg P FIR - Ragland, John IR - Ragland J FIR - Rothlind, Johannes IR - Rothlind J FIR - Seel, Ronald IR - Seel R FIR - Soety, Elizabeth IR - Soety E FIR - Storzbach, Daniel IR - Storzbach D FIR - Troster, Alexander IR - Troster A FIR - York, Michele IR - York M EDAT- 2010/06/04 06:00 MHDA- 2010/06/12 06:00 CRDT- 2010/06/04 06:00 PHST- 2010/06/04 06:00 [entrez] PHST- 2010/06/04 06:00 [pubmed] PHST- 2010/06/12 06:00 [medline] AID - 362/22/2077 [pii] AID - 10.1056/NEJMoa0907083 [doi] PST - ppublish SO - N Engl J Med. 2010 Jun 3;362(22):2077-91. doi: 10.1056/NEJMoa0907083.