@article{ref1,
title="Neurostimulation for Parkinson's disease with early motor complications",
journal="New England journal of medicine",
year="2013",
author="Schuepbach, W.M.M. and Rau, J. and Knudsen, K. and Volkmann, J. and Krack, P. and Timmermann, L. and Hälbig, T.D. and Hesekamp, H. and Navarro, S.M. and Meier, N. and Falk, D. and Mehdorn, M. and Paschen, S. and Maarouf, M. and Barbe, M.T. and Fink, G.R. and Kupsch, A. and Gruber, D. and Schneider, G.-h. and Seigneuret, E. and Kistner, A. and Chaynes, P. and Ory-Magne, F. and Brefel Courbon, C. and Vesper, J. and Schnitzler, A. and Wojtecki, L. and Houeto, J.-l. and Bataille, B. and Maltête, D. and Damier, P. and Raoul, S. and Sixel-Doering, F. and Hellwig, D. and Gharabaghi, A. and Kruger, R. and Pinsker, M.O. and Amtage, F. and Régis, J.-m. and Witjas, T. and Thobois, S. and Mertens, P. and Kloss, M. and Hartmann, A. and Oertel, W.H. and Post, B. and Speelman, H. and Agid, Y. and Schade-Brittinger, C. and Deuschl, G.",
volume="368",
number="7",
pages="610-622",
abstract="BACKGROUND: Subthalamic stimulation reduces motor disability and improves quality of life in patients with advanced Parkinson's disease who have severe levodopa-induced motor complications. We hypothesized that neurostimulation would be beneficial at an earlier stage of Parkinson's disease. <br><br>METHODS: In this 2-year trial, we randomly assigned 251 patients with Parkinson's disease and early motor complications (mean age, 52 years; mean duration of disease, 7.5 years) to undergo neurostimulation plus medical therapy or medical therapy alone. The primary end point was quality of life, as assessed with the use of the Parkinson's Disease Questionnaire (PDQ-39) summary index (with scores ranging from 0 to 100 and higher scores indicating worse function). Major secondary outcomes included parkinsonian motor disability, activities of daily living, levodopa-induced motor complications (as assessed with the use of the Unified Parkinson's Disease Rating Scale, parts III, II, and IV, respectively), and time with good mobility and no dyskinesia. <br><br>RESULTS: For the primary outcome of quality of life, the mean score for the neurostimulation group improved by 7.8 points, and that for the medical-therapy group worsened by 0.2 points (between-group difference in mean change from baseline to 2 years, 8.0 points; P=0.002). Neurostimulation was superior to medical therapy with respect to motor disability (P<0.001), activities of daily living (P<0.001), levodopa-induced motor complications (P<0.001), and time with good mobility and no dyskinesia (P=0.01). Serious adverse events occurred in 54.8% of the patients in the neurostimulation group and in 44.1% of those in the medical-therapy group. Serious adverse events related to surgical implantation or the neurostimulation device occurred in 17.7% of patients. An expert panel confirmed that medical therapy was consistent with practice guidelines for 96.8% of the patients in the neurostimulation group and for 94.5% of those in the medical-therapy group. <br><br>CONCLUSIONS: Subthalamic stimulation was superior to medical therapy in patients with Parkinson's disease and early motor complications. (Funded by the German Ministry of Research and others; EARLYSTIM ClinicalTrials.gov number, NCT00354133.) Copyright © 2013 Massachusetts Medical Society.<p /><p>Language: en</p>",
language="en",
issn="0028-4793",
doi="10.1056/NEJMoa1205158",
url="http://dx.doi.org/10.1056/NEJMoa1205158"
}