Treating Parkinson's disease

January 6, 2009 3:20:28 PM PST
As Americans age, more and more people are being diagnosed with Parkinson's disease. A new study looks at what treatment works best.

The United States' aging population has made Parkinson's disease an increasingly prevalent disease, with symptoms that can include tremors, muscle stiffness and an inability to move. The new study compares two widely accepted forms of treatment for the disease and measures the benefits and risks of each, even for older patients.

Richard Seeger was diagnosed with Parkinson's disease in 1991, and in the following years, saw his movement ability rapidly deteriorate.

"I couldn't get up from the seat," he said. "i'd have to bounce and bounce and bounce until I finally got my legs, my knees locked."

He volunteered to participate in a study comparing two forms of treatment, a surgical procedure called deep brain stimulation and "best medical therapy," defined as treatment by a movement disorders specialist, including a combination of medication and therapies.

"What is unique about this study was that we included older people," said Dr. Frances Weaver, director of the Center for Management of Complex Chronic Care and Hines VA Hospital. "Parkinson's patients are often older, but older people are often excluded from research studies. Twenty-five percent of our population in our study were aged 70 and older."

Richard was chosen at random to undergo surgery, in which very small electrodes were placed in his brain. The electric stimulation was then adjusted to best control his symptoms.

"They turned it on and I tell you what, they couldn't hardly believe it," he said. "I was walking around, not shaking."

The study, featured in this week's Journal of the American Medical Association, found that at six months, patients who received deep brain stimulation increased the amount of time per day that they were able to function normally by 4.6 hours compared with patients receiving best medical therapy.

Significant improvements in most movement functions and quality of life were also measured, and it was found that the extent of benefit was roughly the same for all surgical patients, regardless of age.

"The fact that older patients did almost as well was a very surprising and positive finding for us," Dr. Weaver said.

However, the study also found a higher rate of complications for patients who underwent deep brain stimulation.

"The take-home message from this study is that each patient should weigh the benefit and risks of undergoing deep brain stimulation, but that being older an having Parkinson's does not exclude a person from being appropriate for receiving this treatment," Dr. Weaver said.

Seeger would be the first to agree with that.

Phase two of this study will focus on the placement of the deep brain stimulation implant and compare which of two different sites provides better control of symptoms of Parkinson's disease.

For more information about phase one, visit JAMA.com.

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WEB PRODUCED BY: Bill King

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