Deep brain stimulation improves survival in severe Parkinson
Ngoga D, Mitchell R, Kausar J, Hodson J, Harries A, Pall H. Deep brain stimulation improves survival in severe Parkinson , 2013 Jul 10
Intro: The authors of this study are from the United Kingdom and cite that Parkinson’s disease is a common neurological condition there as much as it is here, in the United States. They discuss typical medicinal treatments being effective early in the disease course and the longer that a person takes them the more motoric challenges will occur (e.g. dyskinesias). They also discuss DBS-STN being an effective treatment to improve motor control as well as quality of life and often reduced need for PD medications. However, they note that there is little to no research looking at DBS-STN on mortality rates of people with PD (PWP).
Methods: A surgical/medical center looked at PWP classified as severe over a 10-year time span that either underwent DBS-STN or declined surgery and continued to only take medications. One hundred and forty seven PWP were studied (41 medication only, 106 DBS-STN), aged 40-70 (mean age in years: 61 medication, 60 DBS-STN).
Results: The two groups were not significantly different from each other in terms of demographics or levels of depression and both were healthy enough to undergo surgery. Each group was offered to have surgical intervention around the 10-11 year mark of having PD and was on about the same levels of levodopa/carbidopa at the time surgery was discussed.
The study found that the DBS-STN group had “longer survival” than the medication only group. The study did not specify a length of time for additional survival and instead looked at rates of survival. Further analysis found that women had lower survival rates, as were people who had PD greater than 10 years prior to the surgical discussion. Cause of death was also more likely to be respiratory related in the medication only group than the DBS-STN group.
The study also looked into rates of placement into nursing home settings and found that the group only treated with medication was more likely to be admitted to a residential care setting.
Conclusion: The DBS-STN group had better survival rates and was less likely to be admitted into a nursing home setting than the group that chose to be treated only with medications. Various reasons were discussed including improved “motor functioning, mobility, quality of life,” and possibly swallowing leading to less nursing home admissions and fewer deaths. The groups, although not randomized, were similar on the majority of demographic and medical variables studied suggesting that the differences in mortality were due to the type of treatment chosen. This study is very important as it contributes to PWP and clinicians being informed consumers when having to choose treatment options for severe PD.