Chicago – Patients with Parkinson's disease who are undergoing a treatment known as deep brain stimulation may benefit from the direct involvement of a neurologist with expertise both in movement disorders and in deep brain stimulation, according to an article posted online today that will appear in the September 2006 print issue of Archives of Neurology, one of the JAMA/Archives journals.
Deep brain stimulation is a surgical procedure that involves implanting electrodes into the brain to electronically stimulate areas that control movement, treating Parkinson's disease symptoms such as tremor, stiffness and problems walking. It is the most effective surgical treatment for advanced cases of Parkinson's disease. Deep brain stimulation involves intensive patient management, including adjustments of electrical currents and medication dosages as a patient's condition changes. Many medical centers in North America delegate these responsibilities to personnel who do not have extensive experience in Parkinson's disease care, such as surgical nurses, fellows or neurophysiologists, according to information in the article.
Elena Moro, M.D., Ph.D., and colleagues at University Health Network, University of Toronto, Ontario, studied whether the outcomes resulting from deep brain stimulation could be improved with the direct involvement of a neurologist with specific expertise both in the treatment of movement disorders in general and in deep brain stimulation in particular. Forty-four consecutive patients at the hospital who had already been receiving regular deep brain stimulation treatments for an average of 3.5 years underwent evaluation by such a neurologist--in other words, the neurologist changed the electric stimulation settings during the procedure and also adjusted the medications that patients received afterward. The patients underwent assessments for Parkinson's disease symptoms before and after their reprogrammed treatment, with following assessments at an average of 5 months (range 1 hour to 14 months) after the reprogramming.
Of the 44 patients, 24 (54.6 percent) showed additional improvement in their Parkinson's disease symptoms; 16 (36.4 percent) were unchanged; and four (9.1 percent) worsened. The patients who did improve experienced fewer tremors and less rigidity and bradykinesia (slowness of movement) and also had reductions in their medication dosages. The four patients who worsened had more speech and gait problems and were returned to their original settings.
"Further improvement of parkinsonian signs can be achieved in the majority of patients even after long-term stable stimulation," the authors conclude. "Improved patient outcomes from subthalamic nucleus deep brain stimulation are obtained when postoperative care is personally managed by a neurologist expert in movement disorders and deep brain stimulation who is directly responsible for stimulation programming and simultaneous drug adjustments based on observed clinical responses to changing stimulation parameters." (Arch Neurol. 2006;63:(doi:10.1001/archneur.63.9.noc60069). Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was partially funded through a Center of Excellence grant from the National Parkinson Foundation and a grant from Medtronic in support of fellow and nurse salaries. Please see full article for complete financial disclosure information.
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