Electromedicine for Parkinson's disease: Deep brain stimulation works better than drugs

"Deep brain stimulation improves the quality of life in patients with advanced Parkinson's disease at a stage when medical treatment is no longer able to improve quality of life," said lead author Dr. Guenther Deuschl, professor of neurology and chairman of the department of neurology at Christian-Albrechts University in Kiel, Germany. "It is important that the time during which these (deep brain stimulation) patients were immobile decreased highly significantly, the time with good mobility increased, and the sleep time also increased."

In the German study, 156 patients with advanced Parkinson's, all under the age of 75, were assessed using standard Parkinson's assessment tools at the beginning of the study, and again at the end. According to the study, two of the tools, the Parkinson's Disease Questionnaire (PDQ) and the Unified Parkinson's Disease Rating Scale (UPDRS), assign a score between 0 and 100 and 0 and 108 respectively, with higher scores identifying more severe symptoms.

Each participant was then randomly assigned to receive either deep brain stimulation or medication. Deep brain stimulation is usually reserved for people with severe symptoms or who no longer get much help from drugs, and is performed by placing a thin, electrically conductive wire deep into the brain. While this doesn't cure Parkinson's disease, it does temporarily block the abnormal brain signals that cause some of the symptoms.

After six months, the patients were reevaluated using the assessment tools, and the patients who underwent deep brain stimulation lowered their PDQ score by 9.5 points and their UPDRS scores by 19.6. The scores of the medication group showed little or no change after the six month interval.

While the medication group showed fewer serious adverse events -- 4 percent versus 13 percent for the deep brain stimulation group -- and one of the patients who underwent the brain stimulation procedure died from a brain hemorrhage, the frequency of the side effects was lower in the deep brain stimulation group; only 50 percent to the medication group's 64 percent.

"While there were certain complications for surgery, overall there seemed to be more complications in the medicine group," noted Dr. Michael Kaplitt, director of movement disorder surgery at Weill Cornell/New York Presbyterian Hospital in New York City. "This raises an interesting question: Should we consider surgery in earlier stages because of the fact that ongoing medical therapy might not be benign?" Kaplitt said, and added that studies of deep brain stimulation in earlier stages of Parkinson's disease are already underway.

"While surgery can be frightening to many people -- understandably -- with a disease such as Parkinson's, it can be extraordinarily beneficial in the proper patient," Kaplitt said.

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