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. 2016 Aug:29:104-8.
doi: 10.1016/j.parkreldis.2016.05.015. Epub 2016 May 17.

Advanced therapies in Parkinson's disease: Long-term retrospective study

Aristide Merola  1 , Alberto J Espay  2 , Alberto Romagnolo  3 , Andrea Bernardini  3 , Laura Rizzi  3 , Michela Rosso  3 , Kristy J Espay  2 , Maurizio Zibetti  3 , Michele Lanotte  3 , Leonardo Lopiano  3
Affiliations

Advanced therapies in Parkinson's disease: Long-term retrospective study

Aristide Merola et al. Parkinsonism Relat Disord. 2016 Aug.

Abstract

Background: Levodopa/carbidopa intestinal gel infusion (LCIG) and subthalamic nucleus deep brain stimulation (STN-DBS) are approved therapies for advanced Parkinson's disease (PD) whose long-term comparability remains unclear.

Methods: We reviewed the 5-year data on activities of daily living (ADL) and motor complications (OFF time, dyskinesia duration, and dyskinesia severity), as measured by the Unified Parkinson Disease Rating Scale (UPDRS) section-II and section-IV (items 39, 32, and 33, respectively) in 60 PD patients exposed to STN-DBS (n = 20), LCIG (n = 20), and oral medical therapy (OMT) (n = 20) at similar baseline disability and cognitive state.

Results: STN-DBS and LCIG showed a similar magnitude of deterioration in ADL (+6.1 vs. +5.7 UPDRS-II; p = 0.709), but lesser than with OMT (+13.7 UPDRS-II; p = 0.005). OFF time also improved to the same extent in STN-DBS and LCIG (-62% vs. -54.5%; p = 0.830), while worsened with OMT (+78.6%; p < 0.001). STN-DBS and LCIG yielded greater improvement on dyskinesia compared to OMT (dyskinesia duration: -66.1% vs. -9.0% vs. +24.2% [p = 0.001]; dyskinesia severity: -68.8% vs. -18.0% vs. +16.2% [p = 0.002]), with relative superiority of STN-DBS over LCIG (p = 0.004 for duration; p = 0.014 for severity). The annualized rate of complication was lower in STN-DBS vs. LCIG (0.13 vs. 0.68; p < 0.001) but not different between STN-DBS and OMT (0.13 vs. 0.10; p = 0.795).

Conclusions: STN-DBS and LCIG showed comparable efficacy in ADL and OFF time, superior to OMT. STN-DBS yielded greater improvement in dyskinesia and lower long-term rate of complications than LCIG.

Keywords: Electrical stimulation; Movement disorders; Neuropharmacology; Neurosurgery; Parkinson’s disease.

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