Jun 30, 2016
In
Parkinson’s disease (PD), medication-based therapy efficacy wanes and “wearing
off” symptoms develop over time. Deep brain stimulation (DBS) is an emerging
major treatment modality in PD, targeting the ventral intermediate thalamic
nucleus for tremor-dominant PD and the subthalamic nucleus and the globus
pallidus interna for akinetic-rigid disease. DBS acts as an adjunctive measure
with medication to reduce dyskinesia and daily doses; it does not replace
medication.
An
article published ahead-of-print in World Neurosurgery indicated that DBS
effectively improved motor function and levodopa equivalence daily doses (LEDD)
in Parkinson’s disease patients 70 years and older.
This
single center retrospective study used the Unified Parkinson's Disease Rating
Scale III to measure motor function.
The
researchers quantified medication requirement with levodopa equivalent daily
doses. DBS decreased average LEDD from 891.94 mg to 559.6 mg and average doses
per day from 11.54 to 7.97. Follow-up beyond two years was rare but the
researchers predicted DBS’ efficacy to diminish over time. Patients’ UPDRS-III
scores decreased from 31.79 pre-operatively to 15.5 postoperatively. This
reduction in motor symptoms is consistent with prior studies in all and older
patients.
Adverse
operative outcomes (e.g. hardware infections, gait disturbances, and speech
problems) were similar to the rates experience in younger cohorts. The study
authors call for long-term follow-up beyond the average 23.5 month follow-up
currently considered standard in studies. Careful selection of surgical
candidates allows access to the motor function and dose reduction benefits of
deep brain stimulation in patients over 70 years old.
http://www.hcplive.com/medical-news/deep-brain-stimulation-is-older-patients-safe
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