A RCT 1 included a total of 255 subjects with advanced Parkinson's disease. They had persistent disabling symptoms despite their current medical regimen. Patients received the best medical therapy possible or underwent deep brain stimulation (DBS) either with subthalamic nucleus or globus pallidus targets. DBS group gained more "on" time, defined as good motor control and function without troubling dyskinesia, compared with those receiving optimal medical therapy (4.6 h vs 0.0 h per day, respectively; mean difference, 4.5 h/d, 95% CI 3.7 to 5.4 h/d). Motor function improvement occurred more often in the DBS group than in the medical therapy group (71% vs 32%; NNT=3). Quality of life scores were also significantly higher in patients receiving DBS. All results were similar in the subgroup of patients 70 years or older. Adverse events, including falls, gait disturbance, depression, dystonia, and surgical site infection, occurred significantly more often in the DBS group. Two deaths occurred in the DBS group compared with none in the optimal medical treatment group. More than 99% of serious adverse side effects resolved by 6 months.
Comment: The quality of evidence is downgraded by study quality (uncertain allocation concealment).
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