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J Neurosurg. 2019 Apr 5:1-9. doi: 10.3171/2018.12.JNS182042. [Epub ahead of print]

Comparing two randomized deep brain stimulation trials for Parkinson's disease.

Author information

1
Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts-University Kiel, Germany.
2
Division of Neurosurgery, University of Nebraska Medical Center.
3
VA Medical Center, Omaha, Nebraska.
4
Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, Illinois.
5
The Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany.
6
Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VA Hospital, Hines, Illinois.
7
Department of Neurology, University Hospital and Julius-Maximilian-University, Wuerzburg, Germany; and.
8
Medtronic, Inc., Minneapolis, Minnesota.

Abstract

Objective:

Several randomized studies have compared the effect of deep brain stimulation (DBS) of the subthalamic nucleus with the best medical treatment in large groups of patients. Important outcome measures differ between studies. Two such major studies, the life-quality study of the German Competence Network for Parkinson’s disease (LQ study) and the US Veterans Affairs/National Institute of Neurological Disorders and Stroke trial (VA/NINDS trial), were compared here in order to understand their differences in outcomes.

Methods:

Unless otherwise noted, analyses were based on those subjects in each study who received a DBS implant (LQ study 76 patients, VA/NINDS trial 140 patients) and who had data for the measurement under consideration (i.e., no imputations for missing data), referred to hereafter as the “as-treated completers” (LQ 69 patients, VA/NINDS 125 patients). Data were prepared and analyzed by biostatisticians at the US Department of Veterans Affairs Cooperative Studies Program Coordinating Center, the Coordinating Center for Clinical Trials Marburg, and Medtronic, under the direction of two authors (G.D. and K.A.F.). Data were extracted from the respective databases into SAS data sets and analyzed using SAS software. Analyses were based on the 6-month follow-up data from both studies because this was the endpoint for the LQ study.

Results:

Pre-DBS baseline demographics differed significantly between the studies, including greater levodopa responsiveness (LDR) in the LQ study population than in the VA/NINDS group. After DBS, LQ subjects demonstrated greater improvement in motor function (Unified Parkinson’s Disease Rating Scale, Motor Examination [UPDRS-III]), activities of daily living (ADLs), and complications of therapy. Medication reduction and improvements in life quality other than ADLs were not significantly different between LQ and VA/NINDS subjects. When the two populations were compared according to pre-DBS LDR, the “full responders” to levodopa (≥ 50% improvement on UPDRS-III with medication) in the two studies showed no significant difference in motor improvement with DBS (LQ 18.5 ± 12.0–point improvement on UPDRS-III vs VA/NINDS 17.7 ± 15.6–point improvement, p = 0.755). Among levodopa full responders, ADLs improved slightly more in the LQ group, but scores on other UPDRS subscales and the Parkinson’s Disease Questionnaire-39 were not significantly different between the two studies.

Conclusions:

This comparison suggests that patient selection criteria, especially preoperative LDR, are the most important source of differences in motor outcomes and quality of life between the two studies.

Abbreviations:

ADL = activity of daily living; DBS = deep brain stimulation; HY = Hoehn and Yahr; L-dopa = levodopa; LDR = levodopa responsiveness; LED = levodopa equivalent dose; LQ study = German Competence Network for Parkinson’s disease study; PD = Parkinson’s disease; PDQ-39 = 39-Item Parkinson’s Disease Questionnaire; PDQ-SI = PDQ summary index; STN = subthalamic nucleus; UPDRS-II = Unified Parkinson’s Disease Rating Scale, Activities of Daily Living; UPDRS-III = UPDRS Motor Examination; UPDRS-IV = UPDRS Complications of Therapy; VA/NINDS = Veterans Affairs/National Institute of Neurological Disorders and Stroke.

KEYWORDS:

ADL = activity of daily living; DBS = deep brain stimulation; HY = Hoehn and Yahr; L-dopa = levodopa; LDR = levodopa responsiveness; LED = levodopa equivalent dose; LQ study = German Competence Network for Parkinson’s disease study; PD = Parkinson’s disease; PDQ-39 = 39-Item Parkinson’s Disease Questionnaire; PDQ-SI = PDQ summary index; Parkinson’s disease; STN = subthalamic nucleus; UPDRS-II = Unified Parkinson’s Disease Rating Scale, Activities of Daily Living; UPDRS-III = UPDRS Motor Examination; UPDRS-IV = UPDRS Complications of Therapy; VA/NINDS = Veterans Affairs/National Institute of Neurological Disorders and Stroke; deep brain stimulation; functional neurosurgery; outcomes

PMID:
30952118
DOI:
10.3171/2018.12.JNS182042

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