| Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. | |
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MedLine Citation:
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PMID: 20519680 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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.) |
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Authors:
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Kenneth A Follett; Frances M Weaver; Matthew Stern; Kwan Hur; Crystal L Harris; Ping Luo; William J Marks; Johannes Rothlind; Oren Sagher; Claudia Moy; Rajesh Pahwa; Kim Burchiel; Penelope Hogarth; Eugene C Lai; John E Duda; Kathryn Holloway; Ali Samii; Stacy Horn; Jeff M Bronstein; Gatana Stoner; Philip A Starr; Richard Simpson; Gordon Baltuch; Antonio De Salles; Grant D Huang; Domenic J Reda; |
Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: The New England journal of medicine Volume: 362 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-03 Completed Date: 2010-06-11 Revised Date: 2010-09-09 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States |
Other Details:
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Languages: eng Pagination: 2077-91 Citation Subset: AIM; IM |
Copyright Information:
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2010 Massachusetts Medical Society |
Affiliation:
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Iowa City Veterans Affairs Medical Center, Iowa City, USA. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00056563; NCT01076452 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Activities of Daily Living Aged Cognition Electric Stimulation Therapy / adverse effects, methods*, mortality Female Follow-Up Studies Globus Pallidus* Humans Intention to Treat Analysis Male Middle Aged Motor Skills* Parkinson Disease / mortality, physiopathology, therapy* Quality of Life Subthalamic Nucleus* Treatment Outcome |
| Investigator | |
Investigator/Affiliation:
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Kenneth Follett / ; Matthew Stern / ; Frances Weaver / ; Dolores Ippolito / ; Gatana Stoner / ; Tammy Barnett / ; Ken Bukowski / ; Rosemarie DeNicolo / ; Kwan Hur / ; Joyce Jimenez / ; Ping Luo / ; Jan Motyka / ; Domenic Reda / ; Theresa Simon / ; Bharat Thakkar / ; Robert Woolson / ; Carol Fye / ; William Gagne / ; Crystal Harris / ; Jill Heemskerk / ; Claudia Moy / ; Paul Sheehy / ; Timothy O'Leary / ; Grant D Huang / ; Louis Fiore / ; Robert Hall / ; Kevin Stroupe / ; Kim Burchiel / ; Kenneth Follett / ; Carol Fye / ; Crystal Harris / ; Jill Heemskerk / ; Kwan Hur / ; William Koller / ; William J Marks / ; Claudia Moy / ; Rajesh Pahwa / ; Domenic Reda / ; Johannes Rothlind / ; Oren Sagher / ; Paul Sheehy / ; Matthew Stern / ; Frances Weaver / ; Roy Bakay / ; Rick Chappell / ; Robert Hart / ; Robert Holloway / ; George McCabe / ; Margaret Schenkman / ; Jamal Taha / ; Julia Buckelew / ; Carol Fye / ; Marilyn Garin / ; Sharon Matzek / ; Donna Smith / ; Jeff Bronstein / ; John Duda / ; Penelope Hogarth / ; Kathryn Holloway / ; Stacy Horn / ; Eugene C Lai / ; William J Marks / ; Ali Samii / ; Farah Atassi / ; Cecilia Bello / ; Lisette Bunting-Perry / ; Tina Conn / ; Alice Cugley / ; Nanette Eubank / ; Linda Fincher / ; Romay Franks / ; Tammy Harris / ; Mariann Haselman / ; Susan Heath / ; Miriam Hirsch / ; Virginia Janovsky / ; Elaine Lanier / ; Mary Lloyd / ; Susan Loehner / ; Susan O'Connor / ; Ligaya Ordonez / ; Heather Maccarone / ; Kelli Massey-Makhoul / ; Mary Matthews / ; Elizabeth Meyn / ; Keiko Mimura / ; Wes Morrow / ; Tammy Searles / ; Jamye Valotta / ; Usha Vasthare / ; Monica Volz / ; Constance Ward / ; Rebecca Warker / ; Heidi Watson / ; Pamela Willson / ; Mark Baron / ; Vincent Calabrese / ; Amy Colcher / ; Emad Farag / ; Eva Henry / ; Jyh-Gong Hou / ; Gail Kang / ; Galit Kleiner-Fisman / ; John Nutt / ; Jill Ostrem / ; Aliya Sarwar / ; Indu Subramanian / ; Zeba Vanek / ; Gordon Baltuch / ; Kim Burchiel / ; Antonio De Salles / ; Jorge Eller / ; Kathryn Holloway / ; Paul Larson / ; Richard Simpson / ; Philip Starr / ; William Carne / ; Tom Erikson / ; Jurg Jaggi / ; Jeffrey Kreutzer / ; Mario Mendez / ; Paul Moberg / ; John Ragland / ; Johannes Rothlind / ; Ronald Seel / ; Elizabeth Soety / ; Daniel Storzbach / ; Alexander Troster / ; Michele York / |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 2010 Sep 2;363(10):987-8; author reply 988 N Engl J Med. 2010 Sep 2;363(10):987; author reply 988 [PMID: 20809850 ] J Neurol. 2010 Aug;257(8):1411-4 [PMID: 20652299 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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