Subthalamic nucleus DBS and globus pallidus interna DBS offer comparable benefits for the motor symptoms of Parkinson's disease.
Subthalamic nucleus (STN) deep brain stimulation (DBS) for patients with Parkinson’s disease has widely been viewed as the more effective treatment, compared to the other form of DBS for patients, globus pallidus interna (GPi) DBS. However, a new study from the National Institute of Neurological Disorders and Stroke challenges this long-standing belief.
The study, led by Frances Weaver, PhD, director of the Center for Management of Complex Clinical Care at Hines VA Hospital and professor of medicine at Loyola University, and Kenneth Follett, MD, PhD, chief of neurosurgery at the University of Nebraska Medical Center in Omaha, revealed that patients who received DBS at either site experienced comparable benefits for the motor symptoms of Parkinson’s disease. Although about half of all patients in both DBS groups experienced serious adverse events — the most serious being a surgical site infection — 99% were resolved by the end of the two-year study period.
Writing in NEJM, the researchers explained that patients who underwent STN DBS required a lower dose of dopaminergic agents than those who were treated with GPi DBS. The NEJM article also discusses two factors that were more negatively impacted after STN DBS.
“One component of processing speed (visuomotor) declined more after subthalamic stimulation than after pallidal stimulation (P=0.03),” the authors wrote. In addition, “the level of depression worsened after subthalamic stimulation and improved after pallidal stimulation (P=0.02).”
Follet said that the results of the study should reassure both physicians who treat Parkinson’s disease and patients who are trying to decide which treatment option may be more beneficial.
“We found that motor outcomes between the two groups were not significantly different,” he said. “Meanwhile, there were very modest differences in mood and cognitive function between the two groups. Physicians and patients can have confidence in both types of DBS, and can make their choice based on the constellation of motor and non-motor symptoms that determine quality of life in Parkinson’s disease.”