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The Parkinson's-Reversing Breakthrough

Medication for Parkinson Disease

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aPercentage improvement from baseline medication off state to medication off/stimulation on at follow-up. bPercentage reduction.

Abbreviations: ADL, activities of daily living; DBSPDSG, Deep Brain Stimulation for Parkinson's Disease Study Group; UPDRS, Unified Parkinson's Disease Rating Scale.

aPercentage improvement from baseline medication off state to medication off/stimulation on at follow-up. bPercentage reduction.

Abbreviations: ADL, activities of daily living; DBSPDSG, Deep Brain Stimulation for Parkinson's Disease Study Group; UPDRS, Unified Parkinson's Disease Rating Scale.

the one-year visit, at three to four years after implant, there was a worsening in UPDRS ADL and motor scores, gait, postural instability, and speech in the medication off/stimulation on condition although other than speech which was never improved, they were all still significantly improved compared to the baseline medication off state.

Two studies have reported five-year post-STN DBS outcomes (32,37). Schupbach et al. (32) examined 30 PD patients five years after STN DBS. They found that UPDRS ADL (40%) and motor scores (54%) as well as axial symptoms (43%) were significantly improved at five years in the medication off/stimulation on condition compared to the baseline medication off state. However, there was a significant worsening in each of these scores compared to the two-year assessment. Dyskinesia (79%) and levodopa equivalent dose (58%) were significantly reduced at five years and there were no significant changes in these variables throughout the five-year period. On the other hand, there was a significant worsening at five years in UPDRS mentation scores, Mattis Dementia Rating Scale scores, and frontal scores compared to baseline. Similarly, Krack et al. (37) examined 42 PD patients 60 months after bilateral STN DBS. In the medication off/stimulation on condition compared to baseline, there was a 54% improvement in UPDRS motor scores and a 49% improvement in UPDRS ADL scores. Significant improvements were seen for tremor (75%), rigidity (71%), akinesia (49%), postural instability (44%), gait (52%), writing (37%), and freezing (46%). Although significantly better than baseline, compared to the one-year visit, there was significant worsening in UPDRS motor and ADL scores, akinesia, gait, and freezing. However, there were sustained reductions in dyskinesia of 71% and daily levodopa equivalence dose of 63%.

In summary, STN DBS has been shown to control tremor, rigidity, bradykine-sia, and dyskinesia up to five years after surgery while allowing a significant reduction in antiparkinsonian medications. Although there is some deterioration over time, this appears to be related to the natural progression of the disease and the majority of symptoms remain improved compared to before surgery.

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