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Subthalamic nucleus‐deep brain stimulation for early motor complications in Parkinson's disease—the EARLYSTIM trial: Early is not always better
Author(s) -
Mestre Tiago A.,
Espay Alberto J.,
Marras Connie,
Eckman Mark H.,
Pollak Pierre,
Lang Anthony E.
Publication year - 2014
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.26024
Subject(s) - deep brain stimulation , subthalamic nucleus , parkinson's disease , motor symptoms , physical medicine and rehabilitation , medicine , clinical trial , movement disorders , disease , psychology , physical therapy
Subthalamic nucleus deep brain stimulation (STN‐DBS) has revolutionized the management of disabling motor complications in Parkinson's disease. The EARLYSTIM trial applied this treatment to patients who had been experiencing motor complications for less than three years. STN‐DBS significantly improved all primary and secondary outcome measures while best medical therapy failed to provide any improvement at the two‐year follow‐up time point. On face value these results strongly favor the application of STN‐DBS far earlier than is currently applied, when patients are just beginning to experience problems with motor complications. Here we review the application of early DBS and the EARLYSTIM trial from the perspectives of clinical issues, health economics and study design and patient expectation of benefit. We conclude that the most relevant issue is not when to operate but on whom and that early is not always better. © 2014 International Parkinson and Movement Disorder Society