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Motor Change Similar With Two Brain-Stimulation Targets

Study looks at stimulation of globus pallidus interna, subthalamic nucleus in Parkinson's patients

WEDNESDAY, June 2 (HealthDay News) -- Pallidal and subthalamic stimulation are associated with similar improvements in motor function over 24 months in patients with Parkinson's disease, and clinicians may reasonably weigh non-motor factors when choosing a surgical target for deep-brain stimulation, according to research published in the June 3 issue of the New England Journal of Medicine.

Kenneth A. Follett, M.D., of the Iowa City Veterans Affairs Medical Center in Iowa, and colleagues analyzed data from 299 patients with idiopathic Parkinson's disease, who were randomly assigned to bilateral stimulation of the globus pallidus interna or subthalamic nucleus.

The researchers found that the groups had similar mean changes in motor function, as assessed by the Unified Parkinson's Disease Rating Scale, part III while patients were stimulated but weren't taking antiparkinsonian medication. However, those receiving subthalamic stimulation needed a lower dose of dopaminergic agents, and this group also had a greater decline in visuomotor processing speed. The subthalamic group also had worsened depression after stimulation, compared to improved depression in the other group.

"The absence of a difference in motor outcomes in the two study groups should serve to reassure clinicians that the choice of target need not focus solely on improvement in motor function. The selection of the target can reasonably take into consideration the constellation of motor and non-motor symptoms that define quality of life for patients with Parkinson's disease," the authors write.

The study was supported in part by Medtronic. Several co-authors disclosed financial relationships with pharmaceutical and medical device companies, including Medtronic.

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