Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial
Identifieur interne : 000045 ( Main/Exploration ); précédent : 000044; suivant : 000046Deep 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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first="P David" last="Charles">P David Charles</name></author><author><name sortKey="Konrad, Peter" sort="Konrad, Peter" uniqKey="Konrad P" first="Peter" last="Konrad">Peter Konrad</name></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><idno type="wicri:Area/Main/Curation">001F20</idno><idno type="wicri:Area/Main/Exploration">000045</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 wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Medicine, Vanderbilt University, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></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 wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Engineering, Vanderbilt University, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Dawant, Benoit" sort="Dawant, Benoit" uniqKey="Dawant B" first="Benoit" last="Dawant">Benoit Dawant</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Engineering, Vanderbilt University, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Allen, Laura" sort="Allen, Laura" uniqKey="Allen L" first="Laura" last="Allen">Laura Allen</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Kao, Chris" sort="Kao, Chris" uniqKey="Kao C" first="Chris" last="Kao">Chris Kao</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></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="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Konrad, Peter" sort="Konrad, Peter" uniqKey="Konrad P" first="Peter" last="Konrad">Peter Konrad</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation><affiliation wicri:level="1"><country wicri:rule="url">États-Unis</country></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><affiliations><list><country><li>États-Unis</li></country><region><li>Tennessee</li></region></list><tree><country name="États-Unis"><region name="Tennessee"><name sortKey="Kahn, Elyne" sort="Kahn, Elyne" uniqKey="Kahn E" first="Elyne" last="Kahn">Elyne Kahn</name></region><name sortKey="Allen, Laura" sort="Allen, Laura" uniqKey="Allen L" first="Laura" last="Allen">Laura Allen</name><name sortKey="Charles, P David" sort="Charles, P David" uniqKey="Charles P" first="P David" last="Charles">P David Charles</name><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><name sortKey="Dawant, Benoit" sort="Dawant, Benoit" uniqKey="Dawant B" first="Benoit" last="Dawant">Benoit Dawant</name><name sortKey="Kao, Chris" sort="Kao, Chris" uniqKey="Kao C" first="Chris" last="Kao">Chris Kao</name><name sortKey="Konrad, Peter" sort="Konrad, Peter" uniqKey="Konrad P" first="Peter" last="Konrad">Peter Konrad</name><name sortKey="Konrad, Peter" sort="Konrad, Peter" uniqKey="Konrad P" first="Peter" last="Konrad">Peter Konrad</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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