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
| Autor: | Adrian, Williams, Steven, Gill, Thelekat, Varma, Crispin, Jenkinson, Niall, Quinn, Rosalind, Mitchell, Richard, Scott, Natalie, Ives, Caroline, Rick, Jane, Daniels, Smitaa, Patel, Keith, Wheatley, T R K, Varma |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Deep brain stimulation Parkinson's disease Activities of daily living Deep Brain Stimulation medicine.medical_treatment Clinical Neurology Disease Severity of Illness Index Antiparkinson Agents Rating scale Surveys and Questionnaires Severity of illness Clinical endpoint medicine Humans Adverse effect Aged Dyskinesias business.industry Parkinson Disease Articles Middle Aged medicine.disease United Kingdom Treatment Outcome Disease Progression Quality of Life Physical therapy Female Neurology (clinical) business Follow-Up Studies |
| Zdroj: | Lancet Neurology |
| Popis: | Summary 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 |
| Databáze: | OpenAIRE |
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