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Research News
January 7, 2009
VA-NIH Trial Results Show Benefits of Deep Brain Stimulation for Some Parkinson's Patients
Results of the largest Parkinson's trial of its kind to date were published in the Jan. 7 Journal of the American Medical Association. Frances Weaver, PhD, a researcher with the HSR&D Center for Management of Complex Chronic Care at the Hines VA Hospital in Illinois, was the lead author and study co-chair for the recently concluded six-year trial comparing deep brain stimulation (DBS) to "best medical therapy" in patients with Parkinson's disease. Parkinson's disease, a progressive neurological disorder, affects some 1.5 million Americans, with 50,000 new cases diagnosed annually. VA treats at least 40,000 veterans with the disorder each year.
Deep brain stimulation for Parkinson's disease has been in use since the late 1990s. Thousands of Americans have had the surgery, with many reporting dramatic improvements in their symptoms, butut questions remain about the procedure's benefits and risks, especially relative to drug therapy. The study concluded that DBS offers effective treatment for a large subset of patients with advanced Parkinson's disease, particularly those who suffer from complications of long-standing drug therapy.
Sponsored by VA's Cooperative Studies Program and the NIH's National Institute of Neurological Disorders and Stroke,* the study compared DBS to "best medical therapy"—carefully managed medication plus speech, physical or occupational therapy, as needed. The study included 255 patients with Parkinson's at seven VA medical centers and six university hospitals. The VA sites included VA's network of Parkinson's Disease Research, Education and Clinical Centers. The patients were randomly divided into two groups: 134 patients continued on "best medical therapy," while the remaining 121 patients received DBS. The patients who received DBS had their medication reduced—or in some cases stopped altogether—as their symptoms improved.
The study authors note however, that DBS does have risks, including: infections, falls, depression, gait and balance problems, and pain, and that the best candidates are patients who have ongoing problems with movement despite medication or who suffer troubling side-effects from the drugs, and who do not have significant cognitive problems or contraindications to surgery. Further, researchers are still exploring which target sites in the brain yield the best results.
(*Additional support for the trial came from Medtronic, which makes the DBS system used in the study.)
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