Deep-brain stimulation for Parkinson’s disease: Pallidal or subthalamic

The implantation of electrodes for stimulation of either the globus pallidus interna or the subthalamic nucleus is accepted treatment for advanced Parkinson’s disease, but which is the best target is not known. Now, a multicentre US trial has shown similar results with stimulation at either site.

A total of 299 patients were randomized at 13 centres to bilateral stimulation of either the globus pallidus interna or the subthalamic nucleus. The primary outcome (change in motor function on the Unified Parkinson’s Disease Rating Scale, part III [UPDRS-III] while receiving stimulation but not anti-Parkinsonian medication) was similar in the two groups, as was self-reported function. Patients in the pallidal stimulation group needed higher doses of dopaminergic drugs but showed less decline in one component of processing speed (visuomotor) compared with the subthalamic stimulation group. Subthalamic stimulation made depression worse but pallidal stimulation improved it. The rate of serious adverse events was similar in the two groups (pallidal 51%, subthalamic 56%). There were no significant differences in quality of life or overall neurocognitive function.

Subthalamic and pallidal stimulation have similar effects on motor function in patients with Parkinson’s disease.

Source: Medical Progress