Abstract
Objective:
To review the literature describing the efficacy and safety of deep brain stimulation (DBS) as an adjunct to pharmacotherapy and to determine the best treatment option for patients with Parkinson disease (PD),
Data Sources:
Literature was obtained through MEDLINE/PubMed (1948-September, week 2, 2011) and a bibliographic review of relevant articles. Key words Included Parkinson disease, medication, pharmacotherapy, surgery, deep brain stimulation, and best medical therapy.
Study Selection and Data Extraction:
Five English-language studies that compared the efficacy of DBS as an adjunct to pharmacologic treatment versus pharmacologic treatment alone in patients with PD met our inclusion criteria and were selected for this review.
Data Synthesis:
PD is a progressive neurodegenerative disease with limited treatment options, and levodopa is considered the pharmacologic gold standard. However, long-term levodopa use leads to decreased efficacy and increased incidence of adverse effects. Hence, DBS has been investigated as an adjunctive option for patients with PD both to overcome the adverse events of levodopa as well as to treat the disease. DBS, when used in conjunction with pharmacologic therapy, has resulted in Improved motor function and quality of life in several trials compared with medication alone. Its benefit is limited by adverse events that are generally more frequent and severe than those with pharmacotherapy alone. Study limitations included small patient population and/or weak design.
Conclusions:
DBS may be an option as adjunct therapy in patients whose symptoms are no longer controlled with maximum pharmacologic therapy, but benefits of surgery must be weighed against the risks.
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