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Deep Brain Stimulation for Early-Stage Parkinson's Disease: An Illustrative Case

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  • For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/bw/submit.asp?ref=1094-7159&site=1

  • Funding: The clinical trial from which this case is presented is supported by Vanderbilt CTSA grant 1 UL1 RR024975 from the National Center for Research Resources, National Institutes of Health, by a research grant from Medtronic, Inc., and by gifts from private donors. The investigators were free to independently design and conduct the research, were responsible for all data analysis and interpretation, and independently wrote and reviewed the manuscript. Dr. Charles, Ms. Gill, and Ms. Allen had complete access to the study data. We would like to thank all contributing authors for their editorial support and advice during the preparation of this manuscript.

  • Conflict of Interest: The clinical trial from which this case is reported is funded by Medtronic, Inc., by Vanderbilt CTSA grant 1 UL1 RR024975 from the NCRR-NIH, and by private donations. Medtronic representatives did not take part in data collection, management, analysis, or interpretation of the data or in preparation, review, or approval of the manuscript. Drs. Charles, Davis, Konrad, and Kao have received personal compensation from Medtronic in the past. Vanderbilt University has received grants from Medtronic in excess of $10,000 to support research led by Drs. Charles and Konrad. Ms. Gill, Ms. Allen, Dr. Bradenham, Dr. Finder, Dr. Tramontana, Dr. Remple, and Dr. Bliton have no conflicts to disclose.

P. David Charles, MD, Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, Suite A-1106 MCN, Nashville, TN 37232, USA. Email: david.charles@vanderbilt.edu

Abstract

Objectives:  Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective intervention in advanced Parkinson's disease (PD), but its efficacy and safety in early PD are unknown. We are conducting a randomized pilot trial investigating DBS in early PD. This report describes one participant who received bilateral STN-DBS.

Materials and Methods:  Thirty subjects have been randomized to either optimal drug therapy (ODT) or DBS + ODT. Microelectrode recordings from the STN and substantia nigra are collected at implantation. The Unified Parkinson's Disease Rating Scale Motor Subscale (UPDRS-III) is administered in the ON and OFF states semi-annually and neuropsychological function and quality of life are assessed annually. We describe a 54-year-old man with a two-year history of PD who was randomized to DBS + ODT and followed for two years.

Results:  The subject showed a lower STN to substantia nigra ratio of neuronal activity than advanced PD patients, and higher firing rate than non-PD patients. The subject's total UPDRS and UPDRS-III scores improved during the two-year follow-up, while his OFF UPDRS-III score and levodopa equivalent daily dose increased. Quality of life, verbal fluency, and verbal learning improved. He did not experience any serious adverse events.

Conclusions:  This report details the first successful application of bilateral STN-DBS for early-stage PD during a clinical trial.

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