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10-year clinical outcomes of subthalamic nucleus versus pallidal deep brain stimulation for Parkinson’s disease: VA/NINDS CSP #468F
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DOI：10.3389/fneur.2025.1728999.png)
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Abstract
En 中文
ObjectiveThis study aimed to examine the very long-term effects of globus pallidus interna (GPi) or subthalamic nucleus (STN) deep brain stimulation (DBS) on Parkinson’s disease (PD) in a subset of patients enrolled in the CSP468 VA/NINDS prospective randomized trial.MethodsThe primary outcome was the change in off-medication/on-stimulation Unified Parkinson’s Disease Rating Scale III score (UPDRS III) from baseline over time between the two targets at 2; 7; and 10 years. Many secondary outcomes were also explored.ResultsA total of 156 patients were enrolled in this substudy; and data were available for 68 GPi/49 STN participants at 7 years and 49 GPi/28 STN participants at 10 years. There was no overall difference in the time trend between the two targets (p < 0.09). UPDRS III improvements from baseline in the GPi cohort at 2; 7; and 10 years were 39.9% (p < 0.001); 16.4%; (p < 0.001); and 22.3%; (p = 0.10); respectively; and in the STN cohort at 2; 7; and 10 years it was 34.9% (p < 0.001); 16.9%; (p < 0.001); and 32.8%; (p < 0.001); respectively. Tremor subscores showed the greatest reduction; followed by rigidity subscores. Initial improvements in bradykinesia and axial subscores were attenuated; and UPDRS I; II; and III on-medication/on-stimulation scores significantly declined. UPDRS IV scores and motor diaries showed significant long-term improvement; and medication reductions were seen regardless of the target. At 7 and 10 years; the PDQ-39 total score no longer showed improvement; and more severe cognitive impairment was seen in both targets.ConclusionDBS therapy has a significant beneficial effect on overall motor function; dyskinesia; and motor fluctuations over 10 years (regardless of target); though non-motor symptoms progressed. Bradykinesia; axial; and quality-of-life improvement were maintained at 2 years and then declined over time.Clinical trial registrationClinicalTrials.gov; identifier NCT01022073; NCT00056563; NCT01076452.
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