Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson’s disease: target related effect or selection bias?
Identifieur interne : 001508 ( Main/Exploration ); précédent : 001507; suivant : 001509Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson’s disease: target related effect or selection bias?
Auteurs : A. Minguez-Castellanos [Espagne] ; F. Escamilla-Sevilla [Espagne] ; M J Katati [Espagne] ; J M Martin-Linares [Espagne] ; M. Meersmans [Espagne] ; A. Ortega-Moreno [Espagne] ; V. Arjona [Espagne]Source :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2005-01.
English descriptors
- KwdEn :
- CAPIT, core assessment program for intracerebral transplantations, CT, computed tomography, DBS, deep brain stimulation, Gpi, globus pallidus internus, MR, magnetic resonance, PD, Parkinson’s disease, Parkinson’s disease, STN, subthalamic nucleus, UPDRS, Unified Parkinson’s Disease Rating Scale, antiparkinsonian medication, deep brain stimulation, globus pallidus, subthalamic nucleus.
Abstract
Background: Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is favoured over bilateral globus pallidus internus (Gpi) DBS for symptomatic treatment of advanced Parkinson’s disease (PD) due to the possibility of reducing medication, despite lack of definitive comparative evidence. Objective: To analyse outcomes after one year of bilateral Gpi or STN DBS, with consideration of influence of selection bias on the pattern of postsurgical medication change. Methods: The first patients to undergo bilateral Gpi (n = 10) or STN (n = 10) DBS at our centre were studied. They were assessed presurgically and one year after surgery (CAPIT protocol). Results: Before surgery the Gpi DBS group had more dyskinesias and received lower doses of medication. At one year, mean reduction in UPDRS off medication score was 35% and 39% in the Gpi and STN groups, respectively (non-significant difference). Dyskinesias reduced in proportion to presurgical severity. The levodopa equivalent dose was significantly reduced only in the STN group (24%). This study high-lights the absence of significant differences between the groups in clinical scales and medication dose at one year. In the multivariate analysis of predictive factors for off-state motor improvement, the presurgical levodopa equivalent dose showed a direct relation in the STN and an inverse relation in the Gpi group. Conclusion: Differences in the patterns of medication change after Gpi and STN DBS may be partly due to a patient selection bias. Both procedures may be equally useful for different subgroups of patients with advanced PD, Gpi DBS especially for patients with lower threshold for dyskinesia.
Url:
DOI: 10.1136/jnnp.2003.032623
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Objective: To analyse outcomes after one year of bilateral Gpi or STN DBS, with consideration of influence of selection bias on the pattern of postsurgical medication change. Methods: The first patients to undergo bilateral Gpi (n = 10) or STN (n = 10) DBS at our centre were studied. They were assessed presurgically and one year after surgery (CAPIT protocol). Results: Before surgery the Gpi DBS group had more dyskinesias and received lower doses of medication. At one year, mean reduction in UPDRS off medication score was 35% and 39% in the Gpi and STN groups, respectively (non-significant difference). Dyskinesias reduced in proportion to presurgical severity. The levodopa equivalent dose was significantly reduced only in the STN group (24%). This study high-lights the absence of significant differences between the groups in clinical scales and medication dose at one year. In the multivariate analysis of predictive factors for off-state motor improvement, the presurgical levodopa equivalent dose showed a direct relation in the STN and an inverse relation in the Gpi group. Conclusion: Differences in the patterns of medication change after Gpi and STN DBS may be partly due to a patient selection bias. Both procedures may be equally useful for different subgroups of patients with advanced PD, Gpi DBS especially for patients with lower threshold for dyskinesia.</div></front></TEI><affiliations><list><country><li>Espagne</li></country></list><tree><country name="Espagne"><noRegion><name sortKey="Minguez Castellanos, A" sort="Minguez Castellanos, A" uniqKey="Minguez Castellanos A" first="A" last="Minguez-Castellanos">A. Minguez-Castellanos</name></noRegion><name sortKey="Arjona, V" sort="Arjona, V" uniqKey="Arjona V" first="V" last="Arjona">V. Arjona</name><name sortKey="Escamilla Sevilla, F" sort="Escamilla Sevilla, F" uniqKey="Escamilla Sevilla F" first="F" last="Escamilla-Sevilla">F. Escamilla-Sevilla</name><name sortKey="Katati, M J" sort="Katati, M J" uniqKey="Katati M" first="M J" last="Katati">M J Katati</name><name sortKey="Martin Linares, J M" sort="Martin Linares, J M" uniqKey="Martin Linares J" first="J M" last="Martin-Linares">J M Martin-Linares</name><name sortKey="Meersmans, M" sort="Meersmans, M" uniqKey="Meersmans M" first="M" last="Meersmans">M. Meersmans</name><name sortKey="Ortega Moreno, A" sort="Ortega Moreno, A" uniqKey="Ortega Moreno A" first="A" last="Ortega-Moreno">A. Ortega-Moreno</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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