GPi vs STN deep brain stimulation for Parkinson disease
| العنوان: | GPi vs STN deep brain stimulation for Parkinson disease |
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| المؤلفون: | Odekerken, V.J.J., Boel, J.A., Schmand, B.A., Haan, R.J. de, Figee, M., Munckhof, P. van den, Schuurman, P.R., Bie, R.M.A. de, NSTAPS Study Grp |
| المساهمون: | ANS - Neurodegeneration, Neurology, Graduate School, Medical Psychology, AMS - Amsterdam Movement Sciences, APH - Amsterdam Public Health, Clinical Research Unit, Adult Psychiatry, Neurosurgery, Other departments, Brein en Cognitie (Psychologie, FMG), Movement Disorder (MD) |
| المصدر: | Neurology, 86(8), 755-761. Lippincott Williams and Wilkins Neurology, 86(8), 755-761 Neurology, 86(8), 755-761. Lippincott Williams & Wilkins Neurology, 86(8), 755-761. LIPPINCOTT WILLIAMS & WILKINS |
| بيانات النشر: | Lippincott Williams & Wilkins, 2016. |
| سنة النشر: | 2016 |
| مصطلحات موضوعية: | Male, 0301 basic medicine, Levodopa, medicine.medical_specialty, Deep brain stimulation, Deep Brain Stimulation, medicine.medical_treatment, Globus Pallidus, behavioral disciplines and activities, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Subthalamic Nucleus, law, Interquartile range, medicine, Humans, Aged, Netherlands, Parkinson Disease, Cognition, Middle Aged, nervous system diseases, Subthalamic nucleus, Treatment Outcome, 030104 developmental biology, Globus pallidus, Mood, surgical procedures, operative, nervous system, Anesthesia, Physical therapy, Female, Neurology (clinical), Psychology, therapeutics, 030217 neurology & neurosurgery, Follow-Up Studies, medicine.drug |
| الوصف: | OBJECTIVE: To compare motor symptoms, cognition, mood, and behavior 3 years after deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and subthalamic nucleus (STN) in advanced Parkinson disease (PD).METHODS: Patients with PD eligible for DBS were randomized to bilateral GPi DBS and bilateral STN DBS (1:1). The primary outcome measures were (1) improvement in motor symptoms in off-drug phase measured with the Unified Parkinson Disease Rating Scale (UPDRS) and (2) a composite score for cognitive, mood, and behavioral effects, and inability to complete follow-up at 36 months after surgery.RESULTS: Of the 128 patients enrolled, 90 were able to complete the 3-year follow-up. We found significantly more improvement of motor symptoms after STN DBS (median [interquartile range (IQR)] at 3 years, GPi 33 [23-41], STN 28 [20-36], p = 0.04). No between-group differences were observed on the composite score (GPi 83%, STN 86%). Secondary outcomes showed larger improvement in off-drug functioning in the AMC Linear Disability Scale score after STN DBS (mean ± SD, GPi 65.2 ± 20.1, STN 72.6 ± 18.0, p = 0.05). Medication was reduced more after STN DBS (median levodopa equivalent dose [IQR] at 3 years, GPi 1,060 [657-1,860], STN 605 [411-875], p < 0.001). No differences in adverse effects were recorded, apart from more reoperations to a different target after GPi DBS (GPi n = 8, STN n = 1).CONCLUSIONS: Off-drug phase motor symptoms and functioning improve more after STN DBS than after GPi DBS. No between-group differences were observed on a composite score for cognition, mood, and behavior, and the inability to participate in follow-up.CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that STN DBS provides more off-phase motor improvement than GPi DBS, but with a similar risk for cognitive, mood, and behavioral complications. |
| اللغة: | English |
| تدمد: | 1526-632X 0028-3878 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ad321b8cd7aba4de2fbac63975546b87Test https://doi.org/10.1212/WNL.0000000000002401Test |
| حقوق: | RESTRICTED |
| رقم الانضمام: | edsair.doi.dedup.....ad321b8cd7aba4de2fbac63975546b87 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1526632X 00283878 |
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