Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial
Identifieur interne : 001F20 ( Main/Curation ); précédent : 001F19; suivant : 001F21Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial
Auteurs : Elyne Kahn [États-Unis] ; Pierre-Francois D'Haese [États-Unis] ; Benoit Dawant [États-Unis] ; Laura Allen [États-Unis] ; Chris Kao [États-Unis] ; P David Charles [États-Unis] ; Peter Konrad [États-Unis]Source :
- 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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xml:lang="fr">États-Unis</country><wicri:regionArea>School of Engineering, Vanderbilt University, Nashville, Tennessee</wicri:regionArea></affiliation></author><author><name sortKey="Dawant, Benoit" sort="Dawant, Benoit" uniqKey="Dawant B" first="Benoit" last="Dawant">Benoit Dawant</name><affiliation wicri:level="1"><mods:affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Engineering, Vanderbilt University, Nashville, Tennessee</wicri:regionArea></affiliation></author><author><name sortKey="Allen, Laura" sort="Allen, Laura" uniqKey="Allen L" first="Laura" last="Allen">Laura Allen</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Vanderbilt University Medical Center, 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Tennessee</wicri:regionArea></affiliation></author><author><name sortKey="Konrad, Peter" sort="Konrad, Peter" uniqKey="Konrad P" first="Peter" last="Konrad">Peter Konrad</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>E-mail: peter.konrad@vanderbilt.edu</mods:affiliation><country wicri:rule="url">États-Unis</country></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 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wicri:level="1"><mods:affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Engineering, Vanderbilt University, Nashville, Tennessee</wicri:regionArea></affiliation></author><author><name sortKey="Dawant, Benoit" sort="Dawant, Benoit" uniqKey="Dawant B" first="Benoit" last="Dawant">Benoit Dawant</name><affiliation wicri:level="1"><mods:affiliation>School of Engineering, Vanderbilt University, Nashville, Tennessee, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Engineering, Vanderbilt University, Nashville, Tennessee</wicri:regionArea></affiliation></author><author><name sortKey="Allen, Laura" sort="Allen, Laura" uniqKey="Allen L" first="Laura" last="Allen">Laura Allen</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea></affiliation></author><author><name sortKey="Kao, Chris" sort="Kao, Chris" uniqKey="Kao C" first="Chris" last="Kao">Chris Kao</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea></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 wicri:level="1"><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation><country 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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></record>Pour manipuler ce document sous Unix (Dilib)
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