MILWAUKEE, WI – A study published today in the New England Journal of Medicine shows that the use of deep brain stimulation (DBS) in earlier stages of Parkinson’s disease significantly improves the overall quality of life and social functioning in patients.
This German-French study (EARLYSTIM), led by Prof. Günther Deuschl, Kiel, Germany, and Prof. Yves Agid, Paris, France, demonstrates results in favor of DBS compared to medical treatment among patients in the early stages of Parkinson’s disease. To date, DBS is only used for patients who have already undergone personal, professional and social degradation due to severe motor complications with disease duration of more than 11 years. The aim of the EARLYSTIM study was to assess the use of this therapy in earlier stages, when motor complications have just developed and before patients are significantly affected in their social and occupational functioning.
The study randomized 251 patients to DBS or best medical treatment. These patients had a much shorter disease duration of 7.5 years. The main outcome was quality of life measured with a Parkinson QoL-questionaire (PDQ-39). DBS-patients had an improvement of 26% of their life quality versus no improvement in the medically-treated group and a similar improvement of social functioning (SCOPA-PS). Mobility under worst conditions (UPDRS II, without medication) was improved by 53%, activities of daily living (UPDRS II) were improved by 30% and Levodopa-induced complications were improved by 61% (UPDRS IV).
Largely, all of these outcome measures were significantly better compared to the control group, and depression was also improved. Among the side effects, suicides or suicide attempts were found in both groups with a similar frequency, suggesting it is not neurostimulation itself that is associated with an increased risk for suicides, but patients seeking this treatment. This has important implications for counseling of patients.
“The study showed surprisingly homogeneous results in favor of DBS compared with medical treatment. The most important result is that quality of life of these patients and their social functioning was significantly improved. It is also meaningful that the operation has fewer side effects in this younger population than in advanced disease,” says Deuschl.
Matthew Stern, MD, of the University of Pennsylvania states, “This study extends observations on the effects of DBS in Parkinson’s disease and documents the benefits of surgery even in patients earlier in the course of disease with mild motor fluctuations. Further, using a quality of life scale as the primary analysis emphasizes the meaningful impact of surgery on the lives of affected patients.”
Deuschl says, “This study has the potential to change the international guidelines for the treatment of Parkinson’s disease and will put DBS as a treatment option at a much earlier stage of disease severity.”
Stern adds, “While it is premature to recommend DBS to all patients with motor complications, particularly earlier in the course of PD, it can now be considered a treatment option in this group of individuals. The EARLYSTIM trial will surely fuel the debate on the impact of DBS on disease progression further and underscores the need for long term follow up of the EARLYSTIM patients.”
Prof. Dr. Günther Deuschl
Department of Neurology, Christian-Albrechts-University Kiel,
24105 Kiel, Germany
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