Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial

Adrian Williams, Steven Gill, Thelekat Varma, Crispin Jenkinson, Niall Quinn, Rosalind Mitchell, Richard Scott, Natalie Ives, Caroline Rick, Jane Daniels, Smitaa Patel, Keith Wheatley, Carl Counsell (Collaborator), PD SURG Collaborative Group

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Abstract

BACKGROUND: Surgical intervention for advanced Parkinson's disease is an option if medical therapy fails to control symptoms adequately. We aimed to assess whether surgery and best medical therapy improved self-reported quality of life more than best medical therapy alone in patients with advanced Parkinson's disease. METHODS: The PD SURG trial is an ongoing randomised, open-label trial. At 13 neurosurgical centres in the UK, between November, 2000, and December, 2006, patients with Parkinson's disease that was not adequately controlled by medical therapy were randomly assigned by use of a computerised minimisation procedure to immediate surgery (lesioning or deep brain stimulation at the discretion of the local clinician) and best medical therapy or to best medical therapy alone. Patients were analysed in the treatment group to which they were randomised, irrespective of whether they received their allocated treatment. The primary endpoint was patient self-reported quality of life on the 39-item Parkinson's disease questionnaire (PDQ-39). Changes between baseline and 1 year were compared by use of t tests. This trial is registered with Current Controlled Trials, number ISRCTN34111222. FINDINGS: 366 patients were randomly assigned to receive immediate surgery and best medical therapy (183) or best medical therapy alone (183). All patients who had surgery had deep brain stimulation. At 1 year, the mean improvement in PDQ-39 summary index score compared with baseline was 5.0 points in the surgery group and 0.3 points in the medical therapy group (difference -4.7, 95% CI -7.6 to -1.8; p=0.001); the difference in mean change in PDQ-39 score in the mobility domain between the surgery group and the best medical therapy group was -8.9 (95% CI -13.8 to -4.0; p=0.0004), in the activities of daily living domain was -12.4 (-17.3 to -7.5; p
Original languageEnglish
Pages (from-to)581-591
Number of pages11
JournalThe Lancet neurology
Volume9
Issue number6
DOIs
Publication statusPublished - Jun 2010

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Keywords

  • adult
  • aged
  • antiparkinson agents
  • deep brain stimulation
  • disease progression
  • dyskinesias
  • female
  • follow-up studies
  • Great Britain
  • humans
  • male
  • middle aged
  • Parkinson disease
  • quality of life
  • questionnaires
  • severity of illness index
  • time factors
  • treatment outcome

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