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Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease: target related effect or selection bias?
J Neurol Neurosurg Psychiatry. 2005 Jan; 76(1):34-9.JN

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.

Authors+Show Affiliations

Servicio de Neurología, Hospital Virgen de las Nieves, CRT 3 planta, Carretera de Jaén s/n, 18013 Granada, Spain. aminguezc@meditex.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15607992

Citation

Minguez-Castellanos, A, et al. "Different Patterns of Medication Change After Subthalamic or Pallidal Stimulation for Parkinson's Disease: Target Related Effect or Selection Bias?" Journal of Neurology, Neurosurgery, and Psychiatry, vol. 76, no. 1, 2005, pp. 34-9.
Minguez-Castellanos A, Escamilla-Sevilla F, Katati MJ, et al. Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease: target related effect or selection bias? J Neurol Neurosurg Psychiatry. 2005;76(1):34-9.
Minguez-Castellanos, A., Escamilla-Sevilla, F., Katati, M. J., Martin-Linares, J. M., Meersmans, M., Ortega-Moreno, A., & Arjona, V. (2005). Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease: target related effect or selection bias? Journal of Neurology, Neurosurgery, and Psychiatry, 76(1), 34-9.
Minguez-Castellanos A, et al. Different Patterns of Medication Change After Subthalamic or Pallidal Stimulation for Parkinson's Disease: Target Related Effect or Selection Bias. J Neurol Neurosurg Psychiatry. 2005;76(1):34-9. PubMed PMID: 15607992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease: target related effect or selection bias? AU - Minguez-Castellanos,A, AU - Escamilla-Sevilla,F, AU - Katati,M J, AU - Martin-Linares,J M, AU - Meersmans,M, AU - Ortega-Moreno,A, AU - Arjona,V, PY - 2004/12/21/pubmed PY - 2005/2/9/medline PY - 2004/12/21/entrez SP - 34 EP - 9 JF - Journal of neurology, neurosurgery, and psychiatry JO - J Neurol Neurosurg Psychiatry VL - 76 IS - 1 N2 - 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. SN - 0022-3050 UR - https://www.unboundmedicine.com/medline/citation/15607992/Different_patterns_of_medication_change_after_subthalamic_or_pallidal_stimulation_for_Parkinson's_disease:_target_related_effect_or_selection_bias L2 - https://jnnp.bmj.com/lookup/pmidlookup?view=long&pmid=15607992 DB - PRIME DP - Unbound Medicine ER -