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VA-NIH Study Offers Hope for
Parkinson’s Patients
January 13, 2009
Study Says Deep-Brain Stimulation Has Benefits
WASHINGTON -- Electrical stimulation of the brain -- a treatment in which
a pacemaker-like device sends pulses to electrodes implanted in the brain
-- is riskier than drug therapy but may hold significant benefits for
those with Parkinson’s disease who no longer respond well to medication
alone.
That is the conclusion of researchers from the Department of Veterans
Affairs (VA) and National Institutes of Health (NIH) who conducted a
six-year study comparing deep-brain stimulation (DBS) to medication, along
with speech, physical or occupational therapy, given as needed. The
results of the trial, the largest of its kind to date, appear in the
January 7 Journal of the American Medical Association (JAMA).
“Deep-brain stimulation offers hope for a large number of patients with
advanced Parkinson’s disease who suffer from complications of
long-standing medication therapy,” said Secretary of Veterans Affairs Dr.
James B. Peake. “This finding could mean improved quality of life for some
of our patients.”
The study included 255 Parkinson’s patients at seven VA medical centers
and six university hospitals. The VA sites were Portland, Ore., Seattle,
San Francisco, Los Angeles, Houston, Richmond, Va., and Philadelphia, all
members of VA’s network of Parkinson’s Disease Research, Education and
Clinical Centers.
The JAMA article also noted VA’s nationwide system of hospitals and
specialized centers of excellence make the Department uniquely capable of
conducting such large, multi-site trials of new therapies and medical
devices. VA’s patient population is especially suited for trials of
treatments for chronic disease in the elderly.
Patients who took part in the study were on medication but are no longer
seeing improvements in symptoms such as tremors or stiffness. Many were
also developing side effects from the drugs, such as involuntary face, arm
or leg movements.
Researchers followed the patients for six months, finding:
* Patients who received DBS gained an average of 4.6 hours per day of good
motor control and few or no involuntary movements, compared with no gain
for those on medical therapy alone;
* 71 percent of DBS patients showed significant gains in motor function,
compared with only 32 percent of drug therapy patients; and
* Serious adverse side effects were nearly four times more common in the
DBS group, but almost all of these effects in both groups were resolved
during the six-month study. The most common side effects from DBS were
infections, falls, depression, gait and balance problems, and pain.
Lead authors and study co-chairs were Frances Weaver, PhD, a researcher
with the Center for Management of Complex Chronic Care at the Hines VA
Hospital near Chicago, and Dr. Kenneth Follett, a neurosurgeon at the
Omaha VA Medical Center and University of Nebraska. They emphasize that
besides the higher likelihood of serious side effects with DBS compared
with drug therapy, another drawback of the procedure is that, although it
generally improves movement, it does little to help other Parkinson’s
symptoms such as depression, decline in mental ability, gait and balance
problems, and trouble with gastrointestinal, urinary or sexual function.
“The results of the study should not be over- or under-stated,” said Dr.
Michael Kussman, VA’s Under Secretary for Health. “Still, there are many
good candidates for DBS among patients with Parkinson’s disease whom we
treat in VA.”
The trial was sponsored by VA’s Cooperative Studies Program and the
National Institute of Neurological Disorders and Stroke, part of the
National Institutes of Health. Additional support came from Medtronic,
which makes the DBS system used in the study.
Parkinson’s disease, a progressive neurological disorder, affects some 1.5
million Americans, with 50,000 new cases diagnosed annually. VA treats at
least 40,000 veterans with the disorder each year. Most patients are over
age 50, but some forms of the disease can strike younger adults.
-------------------------
posted by Larry
Scott
Founder and Editor
VA Watchdog dot Org
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