Previous randomized controlled trials established the efficacy of deep brain stimulation (DBS) for patients with advanced Parkinson’s disease (PD), but does DBS have a role earlier in the disease course? The New England Journal of Medicine (Feb. 14, 2013) reported a randomized multicenter trial using blinded assessments to evaluate DBS vs. best medical therapy (BMT) in patients with PD (>4 years disease duration, Hoehn-Yahr < 3) and compared recent motor complications. In almost all domains, the DBS group results were superior to BMT: the DBS group experienced a 26% improvement in quality-of-life measures, the BMT group was 1% worse after 2 years. The DBS group was also significantly better with respect to motor severity (both off and on medications), ADLs, treatment-related complications, and medication requirements (29% decrease in DBS group vs. 21% increase in BMT). In this study, DBS was superior to medical therapy alone at a relatively early stage of Parkinson's disease, in patients who are younger, have shorter duration of disease, and shorter duration of motor complications. Therefore, DBS therapy may be effective for an earlier stage of Parkinson’s disease than currently recommended.
New England Journal of Medicine