-----Original Message-----
From: Meir Weiss [mailto:[log in to unmask]]
Sent: Thursday, June 03, 2010 10:18 AM
Subject: FW: DEEP BRAIN STIMULATION AT TWO DIFFERENT TARGETS PRODUCES
SIMILAR MOTOR IMPROVEMENTS IN PARKINSON'S DISEASE
-----Original Message-----
From: NIH news releases and news items [mailto:[log in to unmask]] On
Behalf Of NIH OLIB (NIH/OD)
Sent: Thursday, June 03, 2010 9:08 AM
To: [log in to unmask]
Subject: DEEP BRAIN STIMULATION AT TWO DIFFERENT TARGETS PRODUCES SIMILAR
MOTOR IMPROVEMENTS IN PARKINSON'S DISEASE
U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH NIH News
National Institute of Neurological Disorders and Stroke (NINDS)
<http://www.ninds.nih.gov/>
Embargoed for Release: Wednesday, June 2, 2010, 5 p.m. EDT
CONTACT: Daniel Stimson, NINDS, 301-496-5751, <e-mail:
[log in to unmask]>
DEEP BRAIN STIMULATION AT TWO DIFFERENT TARGETS PRODUCES SIMILAR MOTOR
IMPROVEMENTS IN PARKINSON'S DISEASE
In a major study, investigators have compared how individuals with
Parkinson's disease respond to deep brain stimulation (DBS) at two different
sites in the brain. Contrary to current belief, patients who received DBS
at either site in the brain experienced comparable benefits for the motor
symptoms of Parkinson's.
The results appear in the June 3, 2010 issue of the New England Journal of
Medicine. This is the latest report from a study that has followed nearly
300 patients at 13 clinical sites for two years. The study was funded by
the Department of Veterans Affairs (VA) and the National Institute of
Neurological Disorders and Stroke (NINDS), part of the National Institutes
of Health. Additional support was provided by Minneapolis-based Medtronic,
Inc., the makers of the DBS systems used in the study.
"These results establish that DBS delivered to these two brain areas linked
to key motor control pathways can have equivalent effects on tremor,
stiffness and other motor symptoms of Parkinson's disease," said Walter
Koroshetz, M.D., deputy director at NINDS. "The important question now
becomes how stimulation at each site affects some of the other important,
non-motor symptoms and how to best individualize DBS therapy."
Motor control problems such as shaking, rigidity, slowed movement and poor
balance are often the first and most troubling symptoms of Parkinson's
disease. In later stages, patients tend to develop a variety of cognitive
and mood problems, including depression, apathy, slowed thinking, confusion,
impaired memory and trouble sleeping.
Medications such as L-dopa can control the motor symptoms of Parkinson's
disease early in its course. The drugs alleviate some non-motor symptoms,
but can worsen others. For patients with advanced disease, the drugs become
less effective and more likely to cause side effects. DBS is a surgical
intervention that can help restore the control of motor symptoms for these
patients. It does not help the non-motor symptoms of Parkinson's, and may
even aggravate them. Most patients continue to take carefully balanced
medications after they start DBS.
When patients receive DBS for Parkinson's, a neurosurgeon precisely guides a
very fine wire into one of two deep brain regions involved in motor control,
the subthalamic nucleus (STN) or the globus pallidus interna (GPi). An
implantable battery is used to send a finely tuned electrical current to
stimulate the brain. Often, dramatic improvement of motor symptoms can be
observed in the operating room when the wire is properly placed and the
stimulator turned on. Stimulation on both sides of the brain, or
bilaterally, is considered most effective.
[The html version of this release contains the following image at:
http://www.ninds.nih.gov/img/DBS_Parkinson.gif]
There is a widely held view that of the two techniques, STN DBS is more
effective at controlling motor symptoms but more likely to aggravate
non-motor symptoms. The new study - the largest most comprehensive study
ever done of patients receiving bilateral STN DBS or GPi DBS - challenges
these ideas.
"We found that motor outcomes between the two groups were not significantly
different. Meanwhile, there were very modest differences in mood and
cognitive function between the two groups," said one of the study's lead
investigators, Dr. Kenneth Follett, M.D., Ph.D., formerly affiliated with
the Iowa City VA Medical Center and now chief of neurosurgery at the
University of Nebraska Medical Center in Omaha. "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."
As reported in 2009, the first part of the study compared bilateral DBS to
best medical therapy, including medication adjustment and physical therapy.
Bilateral DBS showed overall superiority to best medical therapy at
improving motor symptoms and quality of life. In the second part of the
study, 299 patients, including those who initially received best medical
therapy, were randomly assigned to receive either bilateral STN DBS or GPi
DBS.
Over a two-year period, the two groups experienced similar improvements in
scores on the Unified Parkinson's Disease Rating Scale, which measures motor
function. The two groups also reported similar improvements in quality of
life.
On a variety of neuropsychological tests, there were no significant
differences between the two groups. However, the STN DBS group experienced
a greater decline on a test of visuomotor processing speed, which measures
how quickly someone thinks and acts on information. Also, the STN DBS group
had slight worsening on a standard assessment of depression, while the GPi
DBS group had slight improvement on the same test. The importance of these
two differences is not clear, and will be scrutinized in follow-up research,
the investigators say.
In practice, after DBS surgery, the dosage of L-dopa and related medications
is often reduced to prevent side effects such as dyskinesias, which are
uncontrolled movements. In this study, medication use decreased more for
the STN DBS group than for the GPi DBS group. That finding may influence
the DBS target chosen for patients. For some patients, medications can
cause unwanted side effects and a drop in medication may be favorable for
them. For others a drop in medication could unmask symptoms related to
cognition or mood that were previously under control.
About half of all patients in both DBS treatment groups had serious adverse
events, the most common being surgical site infection. By the end of the
two-year study period, 99 percent of all serious adverse events were
resolved. Lower levels of electrical stimulation were needed for STN DBS,
suggesting that over the long term, this procedure might be associated with
lower costs and less need for replacing the pulse generator.
"From this study, we can conclude that of the two most common targets for
DBS, either one is a reasonable option for treating Parkinson's disease,"
said the study's co-lead investigator Dr. Frances Weaver, Ph.D., director of
the Center for Management of Complex Clinical Care at Hines VA Hospital and
professor of medicine at Loyola University, both in Chicago.
The investigators will continue to follow the same patients for several more
years, looking at how the choice of DBS target affects patients' motor
function and quality of life over the long term, as well as other factors
such as the need to replace DBS electronics.
"VA was proud to partner with NINDS in the first comparative effectiveness
study of the two types of DBS in a large, randomized trial," said Joel
Kupersmith, M.D., VA Chief Research and Development Officer. "With the
country's aging population, studies like this on treatments for Parkinson's
offer real hope for individuals with a very debilitating and common disease
of the elderly."
The study was led by Drs. Follett and Weaver; and Matthew Stern, M.D.,
professor of neurology at the University of Pennsylvania and co-director of
the Parkinson's Disease Research, Education and Clinical Center at the
Philadelphia VA Medical Center.
For more information about Parkinson's disease, visit
<http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.ht
m>.
NINDS (www.ninds.nih.gov) is the nation's leading funder of research on the
brain and nervous system. The NINDS mission is to reduce the burden of
neurological disease -- a burden borne by every age group, by every segment
of society, by people all over the world.
The National Institutes of Health (NIH) -- The Nation's Medical Research
Agency -- includes 27 Institutes and Centers and is a component of the U.S.
Department of Health and Human Services. It is the primary federal agency
for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and its programs,
visit <www.nih.gov>.
-----------------
REFERENCE: Follett KA, Weaver FM et al. "Subthalamic versus Pallidal Deep
Brain Stimulation for Parkinson's Disease." New England Journal of Medicine,
June 3, 2010, Vol. 362 (22), pp. 2077-2091.
##
This NIH News Release is available online at:
<http://www.nih.gov/news/health/jun2010/ninds-02.htm>.
To subscribe (or unsubscribe) from this list, go to
<http://service.govdelivery.com/service/subscribe.html?code=USNIH_1>.
__________ Information from ESET NOD32 Antivirus, version of virus signature
database 5168 (20100603) __________
The message was checked by ESET NOD32 Antivirus.
http://www.eset.com
__________ Information from ESET NOD32 Antivirus, version of virus signature
database 5169 (20100603) __________
The message was checked by ESET NOD32 Antivirus.
http://www.eset.com
__________ Information from ESET NOD32 Antivirus, version of virus signature
database 5169 (20100603) __________
The message was checked by ESET NOD32 Antivirus.
http://www.eset.com
-----------------------
To change your mail settings or leave the C-PALSY list, go here:
http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=c-palsy
|
