More on DBS

Research on Deep Brain Stimulation (DBS) continues to provide physicians with more insights into the effectiveness of this treatment for Parkinson's disease.  Recently published in the NEJM 2006, 355:896-908, reports on a randomized trail of DBS reported a 41% reduction in motor symptoms after six months in patients undergoing DBS of the subthalamic nucleus without concurrent anti-PD medications.  In addition to increased mobility and improvement in quality of life, allowing patients more options in planning their daily activities to maximize "on time".  The study used the Unified Parkinson's Disease Rating Scale and the Parkinson's Disease Questionnaire, as well as a patient diary.  This is one of the first studies to attempt to quantify "quality of life" as endpoints in a study looking at the effectiveness of DBS.  Further research is needed on the concurrent use of medications and DBS.

However, just DBS alone is not the answer.  Another study published in the Archives of Neurology 2006; 63:1266-1272 demonstrated that hands-on management by a trained neurologist to adjust medication and stimulation levels in the month's fo9llowing surgery leads to improved functioning.  Improvements in both gait and speech were noted after reprogramming.  The patients in the study had been receiving treatment for an average of 3.5 years and their stimulators had not been adjusted after the first year of implantation.  The response to DBS, like the response to medication, changes over time.  Ongoing monitoring is an important component of quality care.  Over 50% of those patients receiving reprogramming after 1 year experienced further improvement in symptom management.  To get the most benefit from either DBS or medications, neurologist involvement in co-managing the patient is required.  There are no official clinical protocols or guidelines and little formal training in reprogramming.   Therefore,  effective management is based on informed patients, practitioner clinical judgment and expertise.

Careful clinical assessment and follow-up is needed.  If you have any questions on care of patients with Parkinson's disease or movement disorders, contact Dr. Lisa Kokontis at lisa.kokontis@neurosciencegroup.com.
Dr.Kokonits has office hours in New London on Thursdays.