Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial
Identifieur interne : 002234 ( Main/Corpus ); précédent : 002233; suivant : 002235Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial
Auteurs : Elyne Kahn ; Pierre-Francois D'Haese ; Benoit Dawant ; Laura Allen ; Chris Kao ; P David Charles ; Peter KonradSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2012-02.
Abstract
Background Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. Objectives/methods 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. Results 14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior −1.1±1.7 mm, lateral 10.7±1.7 mm and superior −3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients. Conclusions The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.
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DOI: 10.1136/jnnp-2011-300008
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</title><author><name sortKey="Kahn, Elyne" sort="Kahn, Elyne" uniqKey="Kahn E" first="Elyne" last="Kahn">Elyne Kahn</name><affiliation><mods:affiliation>School of Medicine, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="D Haese, Pierre Francois" sort="D Haese, Pierre Francois" uniqKey="D Haese P" first="Pierre-Francois" last="D'Haese">Pierre-Francois D'Haese</name><affiliation><mods:affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Dawant, Benoit" sort="Dawant, Benoit" uniqKey="Dawant B" first="Benoit" last="Dawant">Benoit Dawant</name><affiliation><mods:affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Allen, Laura" sort="Allen, Laura" uniqKey="Allen L" first="Laura" last="Allen">Laura Allen</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Kao, Chris" sort="Kao, Chris" uniqKey="Kao C" first="Chris" last="Kao">Chris Kao</name><affiliation><mods:affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Charles, P David" sort="Charles, P David" uniqKey="Charles P" first="P David" last="Charles">P David Charles</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Konrad, Peter" sort="Konrad, Peter" uniqKey="Konrad P" first="Peter" last="Konrad">Peter Konrad</name><affiliation><mods:affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: peter.konrad@vanderbilt.edu</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:B20365E1AADD7DABB6A53489221595095DE06647</idno><date when="2012" year="2012">2012</date><idno type="doi">10.1136/jnnp-2011-300008</idno><idno type="url">https://api.istex.fr/document/B20365E1AADD7DABB6A53489221595095DE06647/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">002234</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</title><author><name sortKey="Kahn, Elyne" sort="Kahn, Elyne" uniqKey="Kahn E" first="Elyne" last="Kahn">Elyne Kahn</name><affiliation><mods:affiliation>School of Medicine, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="D Haese, Pierre Francois" sort="D Haese, Pierre Francois" uniqKey="D Haese P" first="Pierre-Francois" last="D'Haese">Pierre-Francois D'Haese</name><affiliation><mods:affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Dawant, Benoit" sort="Dawant, Benoit" uniqKey="Dawant B" first="Benoit" last="Dawant">Benoit Dawant</name><affiliation><mods:affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Allen, Laura" sort="Allen, Laura" uniqKey="Allen L" first="Laura" last="Allen">Laura Allen</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Kao, Chris" sort="Kao, Chris" uniqKey="Kao C" first="Chris" last="Kao">Chris Kao</name><affiliation><mods:affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Charles, P David" sort="Charles, P David" uniqKey="Charles P" first="P David" last="Charles">P David Charles</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Konrad, Peter" sort="Konrad, Peter" uniqKey="Konrad P" first="Peter" last="Konrad">Peter Konrad</name><affiliation><mods:affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: peter.konrad@vanderbilt.edu</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2012-02">2012-02</date><biblScope unit="volume">83</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="164">164</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">B20365E1AADD7DABB6A53489221595095DE06647</idno><idno type="DOI">10.1136/jnnp-2011-300008</idno><idno type="href">jnnp-83-164.pdf</idno><idno type="ArticleID">jnnp-2011-300008</idno><idno type="PMID">21890575</idno><idno type="local">jnnp;83/2/164</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. Objectives/methods 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. Results 14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior −1.1±1.7 mm, lateral 10.7±1.7 mm and superior −3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients. Conclusions The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Elyne Kahn</name><affiliations><json:string>School of Medicine, Vanderbilt University, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Pierre-Francois D'Haese</name><affiliations><json:string>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Benoit Dawant</name><affiliations><json:string>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Laura Allen</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Chris Kao</name><affiliations><json:string>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>P David Charles</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Peter Konrad</name><affiliations><json:string>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string><json:string>E-mail: peter.konrad@vanderbilt.edu</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Background Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. Objectives/methods 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. Results 14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior −1.1±1.7 mm, lateral 10.7±1.7 mm and superior −3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients. Conclusions The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.</abstract><qualityIndicators><score>8.109</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>1</keywordCount><abstractCharCount>1623</abstractCharCount><pdfWordCount>4693</pdfWordCount><pdfCharCount>31792</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>243</abstractWordCount></qualityIndicators><title>Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</title><pmid><json:string>21890575</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>83</volume><pages><first>164</first></pages><issn><json:string>0022-3050</json:string></issn><issue>2</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & Psychiatry</title></host><publicationDate>2012</publicationDate><copyrightDate>2012</copyrightDate><doi><json:string>10.1136/jnnp-2011-300008</json:string></doi><id>B20365E1AADD7DABB6A53489221595095DE06647</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/B20365E1AADD7DABB6A53489221595095DE06647/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/B20365E1AADD7DABB6A53489221595095DE06647/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/B20365E1AADD7DABB6A53489221595095DE06647/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2011-09-02</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</title><author><persName><forename type="first">Elyne</forename><surname>Kahn</surname></persName><affiliation>School of Medicine, Vanderbilt University, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Pierre-Francois</forename><surname>D'Haese</surname></persName><affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Benoit</forename><surname>Dawant</surname></persName><affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Laura</forename><surname>Allen</surname></persName><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Chris</forename><surname>Kao</surname></persName><affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">P David</forename><surname>Charles</surname></persName><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author corresp="yes"><persName><forename type="first">Peter</forename><surname>Konrad</surname></persName><email>peter.konrad@vanderbilt.edu</email><affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2012-02"></date><biblScope unit="volume">83</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="164">164</biblScope></imprint></monogr><idno type="istex">B20365E1AADD7DABB6A53489221595095DE06647</idno><idno type="DOI">10.1136/jnnp-2011-300008</idno><idno type="href">jnnp-83-164.pdf</idno><idno type="ArticleID">jnnp-2011-300008</idno><idno type="PMID">21890575</idno><idno type="local">jnnp;83/2/164</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011-09-02</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. Objectives/methods 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. Results 14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior −1.1±1.7 mm, lateral 10.7±1.7 mm and superior −3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients. Conclusions The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.</p></abstract></profileDesc><revisionDesc><change when="2011-09-02">Created</change><change when="2012-02">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/B20365E1AADD7DABB6A53489221595095DE06647/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2011-300008</article-id><article-id pub-id-type="doi">10.1136/jnnp-2011-300008</article-id><article-id pub-id-type="other">jnnp;83/2/164</article-id><article-id pub-id-type="other">jnnp;jnnp-2011-300008</article-id><article-id pub-id-type="pmid">21890575</article-id><article-id pub-id-type="other">164</article-id><article-id pub-id-type="other">jnnp-2011-300008</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><series-title>Research paper</series-title></article-categories><title-group><article-title>Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kahn</surname><given-names>Elyne</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>D'Haese</surname><given-names>Pierre-Francois</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Dawant</surname><given-names>Benoit</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Allen</surname><given-names>Laura</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Kao</surname><given-names>Chris</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Charles</surname><given-names>P David</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Konrad</surname><given-names>Peter</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib></contrib-group><aff id="aff1"><label>1</label>School of Medicine, Vanderbilt University, Nashville, Tennessee, USA</aff><aff id="aff2"><label>2</label>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</aff><aff id="aff3"><label>3</label>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</aff><aff id="aff4"><label>4</label>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</aff><author-notes><corresp><label>Correspondence to</label> Dr P Konrad, Vanderbilt University Medical Center, Department of Neurological Surgery, 4340 Village at Vanderbilt, Nashville, TN 37232-8618, USA; <email>peter.konrad@vanderbilt.edu</email></corresp></author-notes><pub-date pub-type="epub-original"><day>2</day><month>9</month><year>2011</year></pub-date><pub-date pub-type="ppub"><month>2</month><year>2012</year></pub-date><pub-date pub-type="epub"><day>2</day><month>9</month><year>2011</year></pub-date><volume>83</volume><volume-id pub-id-type="other">83</volume-id><volume-id pub-id-type="other">83</volume-id><issue>2</issue><issue-id pub-id-type="other">jnnp;83/2</issue-id><issue-id pub-id-type="other">2</issue-id><issue-id pub-id-type="other">83/2</issue-id><fpage>164</fpage><history><date date-type="received"><day>4</day><month>3</month><year>2011</year></date><date date-type="rev-recd"><day>22</day><month>7</month><year>2011</year></date><date date-type="accepted"><day>1</day><month>8</month><year>2011</year></date></history><permissions><copyright-statement>© 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</copyright-statement><copyright-year>2012</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-83-164.pdf"></self-uri><abstract><sec><title>Background</title><p>Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable.</p></sec><sec><title>Objectives/methods</title><p>15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon.</p></sec><sec><title>Results</title><p>14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior −1.1±1.7 mm, lateral 10.7±1.7 mm and superior −3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients.</p></sec><sec><title>Conclusions</title><p>The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.</p></sec></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>Research paper</partName><title>Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>Research paper</partName><title>Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial</title></titleInfo><name type="personal"><namePart type="given">Elyne</namePart><namePart type="family">Kahn</namePart><affiliation>School of Medicine, Vanderbilt University, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pierre-Francois</namePart><namePart type="family">D'Haese</namePart><affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Benoit</namePart><namePart type="family">Dawant</namePart><affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Laura</namePart><namePart type="family">Allen</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chris</namePart><namePart type="family">Kao</namePart><affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P David</namePart><namePart type="family">Charles</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Peter</namePart><namePart type="family">Konrad</namePart><affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><affiliation>E-mail: peter.konrad@vanderbilt.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2012-02</dateIssued><dateCreated encoding="w3cdtf">2011-09-02</dateCreated><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. Objectives/methods 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. Results 14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior −1.1±1.7 mm, lateral 10.7±1.7 mm and superior −3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients. Conclusions The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.</abstract><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>83</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>164</start></extent></part></relatedItem><identifier type="istex">B20365E1AADD7DABB6A53489221595095DE06647</identifier><identifier type="DOI">10.1136/jnnp-2011-300008</identifier><identifier type="href">jnnp-83-164.pdf</identifier><identifier type="ArticleID">jnnp-2011-300008</identifier><identifier type="PMID">21890575</identifier><identifier type="local">jnnp;83/2/164</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2012, Published by the BMJ Publishing Group Limited. 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