Early cortical pacemaker improves Parkinson’s QoL

Photo Credits: CargoCollective

Parkinson’s disease is currently treated by dopamine agonists followed by deep brain stimulation later in the progression of the disease. However, A group of European researchers suggest deep brain stimulation via brain pacemaker earlier than currently used can improve the quality of life of patients with parkinson’s disease.

Parkinson’s is a neurodegenerative disease that affects mostly those in the upper age of life (> 50 years old), but can affect those as young as 20 if passed through genetics. As less and less dopamine is released by nerves in the brain, chemical messages become weaker and/or non-existent to the point of muscle movement becoming jerky, slow, and rigid. Unwanted shaking deemed ‘tremors’ also may develop. Current treatment is levadopa (a dopamine precursor) or dopamine agonist supplementation followed by (later in the disease) deep brain stimulation (subthalamic nucleus). This is meant to directly stimulate the nerves that are not receiving dopamine as they should.

To test if earlier stimulation than normally initiated could improve parkinson’s patients’ quality of life, a trial with 251 participants with early motor complications who either received normal medical treatment and early neurostimulation or solely normal medical treatment was conducted. The trial lasted two years with patient age averaging 52.

Using the 39 point Parkinson’s Disease Questionnaire, an improvement of 7.8 (average) points was seen in those getting the early stimulation treatment. Those not receiving the early neurostimulation showed an average decrease of 0.2 points at two years (P = 0.002).

The investigation group also showed greater improvement in motor disability (16.4 pt. difference, P <0.001), activities of daily living (6.2 pt. difference, P < 0.001), levodopa-induced motor complications (4.1 pt. difference, P < 0.001), and time without dyskinesia (1.9 hours more, P = 0.01).

Overall the group receiving the early cortical pacemaker for deep brain stimulation showed improvements in their quality of life compared to the group receiving standard medical treatment. Regarding safety however, 17.7% of those with implants had serious adverse events including nonspecific edema. Perhaps these are the risks of the surgery no matter if it comes early on or later in the progression.

This study suggests that deep brain stimulation can be used earlier in the disease progression to significantly improve the quality of life in those with parkinson’s disease.

Reference:
W.M.M. Schuepbach, J. Rau, K. Knudsen, J. Volkmann, P. Krack, L. Timmermann, T.D. Hälbig, H. Hesekamp, S.M. Navarro, N. Meier, D. Falk, M. Mehdorn, S. Paschen, M. Maarouf, M.T. Barbe, G.R. Fink, A. Kupsch, D. Gruber, G.-H. Schneider, E. Seigneuret, A. Kistner, P. Chaynes, F. Ory-Magne, C. Brefel Courbon, J. Vesper, A. Schnitzler, L. Wojtecki, J.-L. Houeto, B. Bataille, D. Maltête, P. Damier, S. Raoul, F. Sixel-Doering, D. Hellwig, A. Gharabaghi, R. Krüger, M.O. Pinsker, F. Amtage, J.-M. Régis, T. Witjas, S. Thobois, P. Mertens, M. Kloss, A. Hartmann, W.H. Oertel, B. Post, H. Speelman, Y. Agid, C. Schade-Brittinger, and G. Deuschl. Neurostimulation for Parkinson’s Disease with Early Motor Complications. The New England Journal of Medicine, 2013.
http://dx.doi.org/10.1056/NEJMoa1205158

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