Although deep brain stimulation (DBS) has revolutionized our approach to therapy for patients with advanced Parkinson's disease, many questions remain. Should DBS be instituted earlier in the course of the disease? Why do some patients show striking improvements whereas others show limited benefi t even when lead locations appear to be similar? Why can some patients markedly reduce medications whereas others cannot? What is the optimal target site for DBS and how does it work? One question that has long been asked but only recently become addressable is how long the therapeutic eff ect of DBS can be sustained in the face of what is still a progressive, neurodegenerative disease? A recent article by Castrioto and colleagues, 'Ten-year outcome of subthalamic stimulation in Parkinson disease', seeks to address this question. The authors report signifi cant improvement at 10 years following the onset of subthalamic nucleus DBS in the off UPDRS (Unifi ed Parkinson's Disease Rating Scale) III total motor score, tremor and bradykinesia subscores, UPDRS II meds on and off scores, and UPDRS IV dyskinesia and motor fl uctuation score as well as a signifi cant reduction in the levodopa equivalent daily dose when compared with baseline. Does this fi nally answer our question of the longevity of DBS? I would suggest not. The article by Castrioto and colleagues provides vidence that some patients can expect improvement for 10 years or longer. However, the young age of onset for patients in this study (average of less than 40 years) combined with a substantial loss of patients to follow-up (23 out of 41) likely leads to a data set that was biased in favor of better long-Term outcomes, making it unlikely that the data from this study can be applied to the majority of older patients undergoing DBS, who are more likely to follow a more progressive course. Thus, the present fi ndings are encouraging for some but are not likely to be predictive for all or even for most of the patients currently undergoing this procedure. In spite of these problems, one cannot help but be encouraged by the results of a study that was done early in the course of implementing DBS and that showscontinued improvement for patients as long as 10 years following implantation.
Bibliographical noteFunding Information:
JLV has received research subcontracts through National Institutes of Health Small Business Innovation Research grant funding from NeuroNexus (Ann Arbor, MI, USA) and Great Lakes NeuroTechnologies (formerly Cleveland Medical; Cleveland, OH, USA). He has received consulting fees from Medtronic (Minneapolis, MN, USA), Boston Scientific (Natick, MA, USA), Ceregene (data safety monitoring board; San Diego, CA, USA), and St. Jude Medical Neuromodulation (Plano, TX, USA). He has received a speaking honorarium from Teva Neuroscience (North Wales, PA, USA).
© 2012 BioMed Central Ltd.