Surgery Provides Better Quality of Life Than Medical Therapy for Advanced Parkinson's Disease: Presented at ANA

By Andrew N. Wilner, MD

SALT LAKE CITY, Utah -- September 25, 2008 -- Surgical treatment of advanced Parkinson's disease (PD) improves quality of life compared to medical treatment, according to research presented here at the American Neurological Association (ANA) 133rd Annual Meeting.

Dubbed "PD SURG," the large, randomised assessment of the relative cost-effectiveness of surgery for PD, is being conducted by researchers in the United Kingdom.

The study enrolled 366 patients with advanced disease who were randomised to surgical (n = 183) or medical treatment (n = 183). Dyskinesia (73%) and severe "off" periods (77%) were the main indications for surgery.

Study patients were a mean of 59 years old, 71% were men, and mean duration of disease was 11 years, according to a works-in-progress presentation held here on September 23. All subjects rated stage <2.5 in the "on" state using the Hoehn and Yahr scale (0 to 5 scale indicating the relative level of disability from PD symptoms).

Deep brain stimulation (DBS) of the subthalamic nucleus was the selected surgical procedure for 98% of the patients in the surgical arm, noted lead author Adrian Williams, MD, Queen Elizabeth Medical Centre, Birmingham, United Kingdom.

At 1-year follow up, patients who had undergone surgery demonstrated statistically significant improvements in 3 of the 8 domains of the Parkinson's Disease Questionnaire (PDQ-39) -- mobility, activities of daily living, and bodily discomfort -- compared with those who had followed medical therapy.

Improvements were also seen in emotional well-being, stigma, and cognition. The overall PDQ score improved by 5.4 points in the surgery arm, but decreased by 0.3 in the medical-therapy arm (P = .0003).

In addition, 15% of the surgery patients had improvements of 16 or more points on the PDQ-39 compared with 2% of the medical-therapy patients. Surgery patients who had major improvements on the PDQ-39 tended to be younger (P = .009), have a shorter duration of PD (P = .05), and have worse PDQ-39 baseline scores (P < .0001).

On the Unified Parkinson's Disease Rating Scale, statistically significant improvements occurred in the surgery group compared with the medical-therapy group.

The authors concluded that the quality-of-life improvements seen after surgery in this study are likely to be meaningful to patients with advanced PD.

PD SURG is the largest study to date comparing surgical to medical treatment in patients with PD.