Do patients with early Parkinson’s Disease benefit from neurostimulation?

Presenter: Spencer K. Hutto, M.D.

Link to Presentation: Journal Club August 2016

Clinical Question: 

Do patients with early Parkinson’s Disease benefit from neurostimulation?

Journal Club Article: 

Schuepbach WM et al.  Neurostimulation for Parkinson’s disease with early motor complications.  New England J Med, 2013 Feb 14;368(7):610-22.    PDF here: nejmoa12058

Methodology:

In this 2-year trial, the authors randomly assigned 251 patients with Parkinson’s disease and early motor complications (mean age, 52 years; mean duration of disease, 7.5 years) to undergo neurostimulation plus medical therapy or medical therapy alone. The primary end point was quality of life, as assessed with the use of the Parkinson’s Disease Questionnaire (PDQ-39) summary index (with scores ranging from 0 to 100 and higher scores indicating worse function). Major secondary outcomes included parkinsonian motor disability, activities of daily living, levodopa-induced motor complications (as assessed with the use of the Unified Parkinson’s Disease Rating Scale, parts III, II, and IV, respectively), and time with good mobility and no dyskinesia.

Presenter’s Conclusions:

  • Notable and extensive conflicts of interest in many of the study investigators
  • Interesting study question though faced with difficulties related to cost and durability of equipment
  • Study conducted in a highly regulated fashion in the best way possible given limitations of surgical intervention and inability to blind patients
  • Methods of intervention effect evaluated by current gold standards utilized for Parkinson’s disease interventions (PDQ-39, UPDRS)
  • Difficult to know exactly how clinically significant QoL findings were
  • Significant benefits achievable with comparable degree of adverse events experienced when DBS studied for advanced PD
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