JASLOK FUNCTIONAL NEURO SURGERY UPDATE

In this Blog I plan to discuss the results of recently published trial of DBS in early motor fluctuations and share our personal experience about it

Dr. Paresh K Doshi

Director of Neurosurgery
pareshkd@gmail.com 

• EARLY STIM trial conducted across Germany(9) and French (7) centres
• 2 yrs. Follow up
• Selection : DBS in early motor fluctuation
• Min. dis. Duration >4yrs
• 251 patients randomized between surgical (124) and medical management (127)
• Average age 52 years
• Average dis. Duration 7.5 years
• PDQ-39 (quality of life) questionnaire was the primary endpoint

Results

• Quality of life (PDQ-39) improved by 24% in surgical group (S Gr) V/s worsening in 1% in medical group (M Gr)
• UPDRS III scores significantly improved (53%) in S Gr and only 1.2% in M Gr
• Levodopa reduction was by 39% in S Gr where as the dose increased by 21% in MGr
• Depression was more common in S Gr
• Motor problems, psychosis and impulse control disorders were more frequent in M Gr
• Most of the other adverse events were similar 
  

Similar debate on "Surgery in early motor fluctuations" at the controversies in Neurology meeting in 2009-Ahmedabad

Discussion

• DBS is now a proven management option for advanced Parkinsodisn's disease
• The average disease duration of patients undergoing DBS in earlier studies was 11-13 as compared to 7.5 years in this study
• The patients were younger (52 yrs) as compared to earlier reports (59-62 yrs) as they were offered surgery earlier
• The PDQ-39 summary index scores were also significantly lower in these study group (30.2 v/s 38.4 {Movement DisordersVol. 17, No. 3, 2002, pp. 539–545})
• The UPDRS III scores which reflect motor disability were 33.2 as compared to 60 or more in other published studies (Doshi et al, Neurol. India, 2004)
• The Levodopa equivalent dose was not much different than that published previously (960 mg v/s 800 mg)
• The improvements in all the above three domains were statistically significant
• Authors concluded that "Neurostimulation in combination with medical therapy can therefore improve motor symptoms better than medical therapy alone at this earlier stage"

PDQ -39 scores for SGr and MGr

OUR RESULTS

• We looked at our data and found 5 patients who met the criteria of these paper
• Our analysis shows similar outcome.
• Better outcome is seen in patients with lesser disease, and this is sustained over time (a follow up of more than 6 years)