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1 deep brain stimulation (STN-DBS) has been shown to
School of Cancer Sciences,
The University of Birmingham,
Birmingham, UK
2
Department of Neurosurgery
Birmingham, Queen Elizabeth
Hospital, Birmingham, UK
3
Wolfson Computer
Laboratories, Queen Elizabeth
Hospital Birmingham,
Birmingham, UK
4
School of Clinical and
Experimental Medicine, College
of Medicine, The University of
Birmingham, Birmingham, UK
Correspondence to
Dr Desire Ngoga, Clinical
research fellow, The University
of Birmingham, School of
Cancer Sciences, Vincent Drive,
Birmingham B15 2TT, UK;
d.g.ngoga@bham.ac.uk
Received 4 December 2012
Revised 21 March 2013
Accepted 30 April 2013
Published Online First
10 July 2013
To cite: Ngoga D,
Mitchell R, Kausar J, et al. J
Neurol Neurosurg Psychiatry
2014;85:17–22.
Ngoga D, et al. J Neurol Neurosurg Psychiatry 2014;85:17–22. doi:10.1136/jnnp-2012-304715
RESEARCH PAPER
Deep brain stimulation improves survival in severe
Parkinson’s disease
Desire Ngoga,1 Rosalind Mitchell,2 Jamilla Kausar,2 James Hodson,3 Anwen Harries,2
Hardev Pall4
ABSTRACT
Objectives Levodopa and other dopaminergic
treatments have not had the expected effect on survival
in Parkinson’s disease (PD). Bilateral subthalamic nucleus
improve motor function, motor fluctuations, health-
related quality of life, and to reduce medication usage
and drug-induced dyskinesia in patients with severe PD
refractory to medical therapy. Little however, has been
described on the impact of STN-DBS on the survival of
these patients. We aim in this study to examine the
impact of STN-DBS on the survival of patients with
severe PD.
Methods Patients who were eligible for STN-DBS were
given the choice of undergoing surgery or continuing on
medical treatment. Those who exercised patient choice
and preferred to continue with medical treatment formed
a control population. All eligible patients seen in a
10-year period are included in this study. Our primary
outcome measure is a difference in mortality between
the two groups with a secondary measure of admission
rates to residential (nursing home) care.
Results 106 patients underwent STN-DBS, and
41 patients exercised patient choice and declined the
procedure. The two groups were matched for age,
gender, ethnicity, duration of disease, rates of pre-
existing depression and Levodopa equivalent doses of
anti-Parkinson’s medications taken. Patients undergoing
STN-DBS had significantly longer survival and were
significantly less likely to be admitted to a residential
care home than those managed purely medically. The
statistical significance of these findings persisted after
adjusting for potential confounding factors (survival:
p=0.002, HR 0.29 (0.13 to 0.64) (residential care home
admission: OR: 0.1 (95% CI 0.0 to 0.3; p<0.001).
Interpretation We show for the first time that there is
a survival advantage of DBS surgery in advanced PD.
The effect of potential bias factors is examined. The
survival advantage may arise for several postulated
reasons, ranging from improvement in axial functions,
such as swallowing, to some as yet unrecognised benefit
of reduction in dopaminergic medication. These findings
are of great interest to both patients with PD and the
health professionals considering the treatment options
for patients with severe PD.
INTRODUCTION
Parkinson’s disease (PD) is a major cause of neuro-
logical disability in the UK, with a prevalence of
100–180 per 100 000 and an increasing incidence
with age.1 Medical treatment of the motor manifesta-
tions is very successful in the early stages of the
Movement disorders
disease, but in advanced disease, motor fluctuations
comprising alternating dyskinesia and akinesia
become suboptimally controlled with drug changes.2
Bilateral subthalamic nucleus deep brain stimula-
tion (STN-DBS) using high-frequency continuous
electrical stimulation to the subthalamic nucleus
through a surgically implanted device,3 has become
established as an effective treatment for the motor
symptoms of patients with advanced PD refractory
to medical management.2 4
Improvements have been demonstrated in Motor
function, Quality of life (using generic scales such
as health-related quality of life and disease-specific
ones such as PDQ 39), and reductions in motor
fluctuation, reduced medication usage and, there-
fore, alleviation of drug-induced dyskinesia.5
Life expectancy is decreased in PD with an OR
of 2.56 (95% CI 2.46 to 2.66; p<0.001), and the
advent of medical treatments does not appear to
have altered either mortality from the condition or
significantly delayed the onset of non-motor fea-
tures of the disease.6
The impact of STN DBS on survival has not pre-
viously been studied. In this study, we examined
the impact of STN-DBS on the survival of patients
with severe PD in a single institution.
METHODS
All patients referred to the joint medical/surgical
movement disorder clinic at our institution during
the 10-year period from January 2002 to 2012
who were eligible for and offered STN DBS were
included in this study. Patients either accepted the
offer of surgery or elected to continue with medical
treatment.
We compared the survival of patients undergoing
STN-DBS as part of their PD management with
that of patients who were offered the procedure
but declined, and therefore continued with
maximal medical therapy. Survival data and that of
admission to residential (nursing) home care were
obtained from follow-up at the movement disorder
clinic, from general medical practitioners and from
enquiries to the Registrar of Deaths (National
Statistics). In order to compare possible confound-
ing factors in both groups, we analysed: age,
gender, ethnicity, duration of disease, past medical
history, including depression and Parkinson’s medi-
cation taken at the time surgery was offered.
Levodopa equivalent doses were used to compare
the medication taken by patients.7 8 Patients consid-
ered for surgery have severe PD demonstrated by
Hoehn & Yahr severity scores of 3–4 in their worst
17
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Movement disorders
off states, Dopa-responsive disease and display motor complica-
tions of therapy including dyskinesia and on/off fluctuations.
Patients who agree to have surgery undergo psychometric
testing which includes: a Dementia Rating Scale II, a Wechsler
Memory Scale 3rd edition (WMS III), an IQ test, and a
Hospital Anxiety and Depression Scale assessment.4 9 Those
patients showing satisfactory psychometric testing proceed to
surgery. Patients showing evidence of neuropsychological
impairment are deemed unsuitable for surgery. Patients with sig-
nificant apathy or ‘off period’ hallucinations were excluded
from both groups. The presence or absence of depressive symp-
toms was corroborated by a neurologist in a neuropsychiatry
movement disorder clinic aided by a consultant psychiatrist.
Those patients declining surgery are referred back to their
treating physician for ongoing medical therapy. Nearly half
these patients were subsequently looked after by the DBS team
neurologist. The opportunity exists for patients to be rereferred
if they change their minds.
The majority of patients considered for surgery are aged
between 40 years and 70 years, though age is not considered an
absolute criterion for surgical eligibility.
Statistical analysis
A range of variables was compared between those who
underwent STN-DBS, and those who were deemed suitable
but declined. Kaplan–Meier curves were then produced for
these two groups, with a Log-Rank test used for comparing
survival.
In order to adjust for any differences between the two groups
at baseline, multivariable Cox regression models were produced.
To account for delay between being offered surgery, and the
surgery being performed, a time-dependent covariate was used.
This treated all patients as being medically managed from the
offer of surgery until surgery was performed, at which point
they moved to the surgical group.
A logistic regression model was then produced from the same
factors, to compare the rates of admission to residential care
between the two treatment groups. All analyses were performed
using IBM SPSS V.19 (IBM SPSS, Chicago, Illinois, USA), with
p<0.05 deemed to be indicative of statistical significance.
Table 1 Univariable comparisons
Full medical management (n=41)
Age when offered surgery (years) 61 (57–66)
Gender
Male (%) 32 (78.0)
Female (%) 9 (22.0)
Ethnicity
Caucasian (%) 38 (92.7)
Asian (%) 3 (7.3)
Duration of disease when offered surgery (years) 10.0 (9.0–14.0)
Levodopa equivalent dose 1192 (672–1983)
Preoperative depression (%) 7 (17.1)
Admitted to residential nursing home (%) 15 (36.6)
Mortality rate (%) 17 (41.5)
Dichotomous data displayed as: ‘n (%)’, with p values from Fisher’s exact tests.
Continuous data displayed as: ‘median (quartiles)’, with p values from Mann–Whitney tests.
*Significant at p<0.05.
STN-DBS, subthalamic nucleus deep brain stimulation.
18
RESULTS
A total of 151 patients were offered surgery during the period
studied, of whom 110 agreed to the procedure. Four of these
patients were refused surgery due to failed psychometric analysis,
and were excluded. This left 106 patients who underwent
STN-DBS (surgical group) and 41 patients who declined the pro-
cedure and continued with full medical management (medical
group) for analysis; 50 of these patients underwent Unified
Parkinson’s disease rating scale (UPDRS) motor score recording.
(Mean ‘off ’ score 47.0, mean ‘on’ score 20.6). Three patients,
who initially turned down the offer of surgery, later had a review
and still reaffirmed their wish to continue with medical treatment.
The median age in the surgical group was 60 years (IQR: 53–
63), with the majority of patients being male (72%) and of
Caucasian ethnicity (94%). The remaining 41 (28%) patients
(median age=61, IQR: 57–66; 78% male; 93% Caucasian)
were managed purely medically. Univariate analysis found no
significant differences between either the ages ( p=0.057),
genders ( p=0.534) or ethnicities ( p=0.710) in the two treat-
ment groups (table 1).
Similarly, the duration of disease at the point that surgery was
offered was comparable across the treatment groups, with a
median of 11.0 years (IQR: 8.8–13.0) in the surgical group, and
10.0 years (IQR: 9.0–14.0) in the medically managed patients
(p=0.413).
In addition to this, the amount of medication prescribed to
patients did not differ significantly between groups, with
median Levodopa equivalent doses of 1192 (IQR: 672–1983)
and 1500 (IQR: 911–2053) in the medical and surgical groups,
respectively ( p=0.082).
There was also no significant difference in the rates of a pre-
existing diagnosis of depression (either treated or untreated) in
the two groups, with 23.6% of surgical and 17.1% of medical
patients being affected ( p=0.505). The durations of follow-up
were also comparable across the groups, with a median of
6.7 years (IQR: 5.5–8.7) for medical and 7.4 years (IQR: 4.4–
8.8) for surgical patients.10
Univariate survival analysis was performed using Kaplan–
Meier survival curves, and a Log-Rank test (figure 1). This
found that patients managed with STN-DBS had significantly
longer survival than those managed purely medically
(p=0.001).
Underwent STN-DBS (n=106) p Value
60 (53–63) 0.057
0.534
76 (71.7)
30 (28.3)
0.710
100 (94.3)
6 (5.7)
11.0 (8.8–13.0) 0.413
1500 (911–2053) 0.082
25 (23.6) 0.505
6 (5.7) <0.001*
18 (17.0) 0.004*
Ngoga D, et al. J Neurol Neurosurg Psychiatry 2014;85:17–22. doi:10.1136/jnnp-2012-304715
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Movement disorders

However, even after adjusting for these effects, the significant

Figure 1 Kalpan–Meier survival curves.
This analysis was then extended to consider other potentially
confounding factors using a Cox regression model (table 2). Of
the additional variables considered, gender was found to signifi-
cantly affect survival, with a HR of 3.03 (95% CI 1.47 to 6.24,
p=0.003), implying that females had the higher risk of mortal-
ity. In addition to this, the duration of disease prior to the offer
of surgery was also found to be significant, with a HR of 2.3
(95% CI 1.0 to 5.2) for patients with disease durations greater
than 10 years, relative to shorter durations ( p=0.042).
difference in survival between the two treatment groups per-
sisted ( p=0.002). The HR for surgical patients, with respect to
medical patients, was 0.29 (0.13 to 0.64).
The secondary outcome of admission to residential care was
then considered. Univariable analysis showed that this was sig-
nificantly more likely in medical patients than in surgical
patients, with rates of 37% and 6%, respectively ( p<0.001).
Binary logistic regression analysis (table 3) showed that this dif-
ference persisted, even after adjustment for other potential con-
founding variables, with an OR for surgical, relative to medical
patients, of 0.1 (95% CI 0.0 to 0.3; p<0.001).
We also looked at the causes of death in both cohorts and found
a broader range in the surgical group compared with the medically
managed patients (table 4 with detailed comparison of deceased
patients in both groups presented in online supplementary table
S1). We found that 20% (8 out of 41) of purely medically
managed patients died from respiratory causes. The rate was sig-
nificantly lower in surgical patients, with only 2% (2 out of 106)
having a main cause of death related to respiratory complications
(Bonferroni adjusted p=0.005) (figure 2).
In order to ensure that the additional mortality in the medic-
ally managed cohort was not related to medical conditions that
predate their review in the movement disorder clinic, we
assessed the past medical history of all medically managed
patients and found depression to be the most commonly listed
previous medical condition and the only one present in more
than one patient.
Significantly more patients having surgery were receiving apo-
morphine by subcutaneous injection or infusion at the time of

Table 2 Cox regression model of patient survival Table 3 Logistic regression model of admission to residential care
home
Factor HR (95% CI) p Value
Factor OR (95% CI) p Value
Treatment group 0.002*
Surgical 0.29 (0.13 to 0.64) 0.002* Treatment group <0.001*
Medical† – – Surgical 0.10 (0.03 to 0.29) <0.001*
Gender 0.003* Medical† – –
Female 3.03 (1.47 to 6.24) 0.003* Gender 0.270
Male† – – Female 1.90 (0.61 to 5.96) 0.270
Ethnic group 0.916 Male† – –
Asian 0.92 (0.19 to 4.37) 0.916 Ethnic group –‡
Caucasian† – – Asian –‡
Duration of disease at offer 0.042* Caucasian† –‡
<10 years† – – Duration of disease at offer 0.440
10+ years 2.31 (1.03 to 5.17) 0.042* <10 years† – –
Age at offer (years) 0.615 10+ years 0.66 (0.23 to 1.90) 0.440
<55† – – Age at offer (years) 0.890
55–59 2.15 (0.63 to 7.36) 0.224 <55† – –
60–64 2.01 (0.64 to 6.38) 0.234 55–59 0.59 (0.13 to 2.77) 0.503
65+ 2.19 (0.62 to 7.74) 0.225 60–64 0.65 (0.15 to 2.75) 0.557
Levodopa equivalent dose 0.412 65+ 0.62 (0.14 to 2.81) 0.537
<1000† – – Levodopa equivalent dose 0.727
1000–1999 1.81 (0.75 to 4.37) 0.752 <1000† – –
2000+ 1.54 (0.58 to 4.09) 0.583 1000–1999 0.62 (0.18 to 2.12) 0.445
Preoperative depression 0.948 2000+ 0.70 (0.18 to 2.65) 0.598
No† – – Preoperative depression 0.984
Yes 1.029 (0.44 to 2.41) 0.948 No† – –
Yes 0.99 (0.24 to 4.01) 0.984
Cox Regression model with a time-dependent covariate. Follow-up commences at the
time that surgery was offered, with all patients starting in the medical group, moving Outcome=admission to residential care home.
to the surgical group postsurgery. *Significant at p<0.05.
*Significant at p<0.05. †Reference category.
†Reference category. ‡Incalculable due to lack of events in the Asian group.

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Movement disorders

pre-existing depression and dopa-equivalent dosage of

Table 4 Mortality rates by cause of death
Parkinson’s medications taken at the time of initial consultation.
Full medical Underwent Bonferroni Additionally, all patients offered surgery had severe PD (Hoehn
management STN-DBS adjusted & Yahr 3–4 in the ‘off ’ state improving to 2 or better in the
Cause of death (n=41) (%) (n=106) (%) p value†
‘on’ state). This gives some, albeit imperfect evidence of match-
Parkinson’s disease 3 (7) 5 (5) 1.000 ing of severity of disease between the two groups.
Cardiovascular 5 (12) 4 (4) 0.580 The most striking findings in this study were significant
Stroke 2 (5) 1 (1) increases in both mortality and admissions to a residential care
IHD/MI 3 (7) 2 (2) home in patients declining surgery compared with patients
Cardiomyopathy 0 (0) 1 (1) undergoing STN-DBS. The significance of these findings per-
Gastrointestinal (GI) 0 (0) 3 (3) 1.000 sisted when variables including age, sex, ethnicity and duration
GI malignancy 0 (0) 1 (1) of disease were accounted for. The additional mortality in med-
GI obstruction 0 (0) 1 (1) ically managed patients could not be attributed to past medical
GI ischaemia 0 (0) 1 (1) history given that all patients were deemed medically fit for
Respiratory 8 (20) 2 (2) 0.005* surgery, and an analysis of the past medical history failed to
PE 1(2) 0 (0) show any increased medical risk factors in the medically
Pneumonia 7 (17) 2 (2) managed patients.
Other causes 1 (2) 4 (4) 1.000 A number of long-term studies have demonstrated the efficacy
UTI 0 (0) 1 (1) of DBS in improving quality of life, motor function and reduc-
Unknown 0 (0) 2 (2) tions in drug-related dyskinesia.5 12 It would seem reasonable,
Accidental 0 (0) 1 (1) therefore, to suggest that this improved mobility and reduction
Lewy body disease 1 (2) 0 (0) in drug-related side effects would reduce the risk of respiratory
Data displayed as: ‘n (% of total cohort)’.
disease.
*Significant at p<0.05. This does appear to have been the case in our study, where a
†Adjusted for five comparisons. significantly higher proportion of medically managed patients
STN-DBS, sub-thalamic nucleus deep brain stimulation.
died of respiratory causes (pneumonia and pulmonary embol-
ism) than among surgically treated patients ( p=0.005). It is
offer of surgery compared with fully medically managed interesting to note that of the patients whose primary cause of
patients. (35% surgical, 7% medical, p=0.006). However, of death was pneumonia, 42% had these attributed on their death
the 19 medically treated patients followed-up at our hospital, certificates to aspiration.
two were on apomorphine prior to the offer of surgery and Indeed aspiration pneumonia is recognised as the most fre-
another seven went onto apomorphine subsequently, that is, quent cause of death in PD,13 14 caused by the effect of bradyki-
47% were on apomorphine during follow-up. nesia, rigidity and dyskinesia on swallowing, as well as
pharyngeal sensory impairment.15 There has been no long-term
systematic study of the effect of STN-DBS on axial symptoms
DISCUSSION such as swallowing. It has been reported that following STN-
A recent study commented ‘Unfortunately, there are currently DBS swallowing may fail to improve or in some cases deterior-
no longitudinal studies of patients with PD who are candidates ate.16 17 However, a number of studies comparing STN-DBS
for DBS but who did not get DBS surgery to compare the patients in the DBS ‘on’ and ‘off ’ state, some using videofluoro-
natural history of symptom progression at this stage of the graphic swallowing studies, suggest that individuals with PD
disease’.11 This study, examining patients considered for exhibited improved oropharyngeal phase of swallowing in the
STN-DBS over a 10-year period, compares two well-matched stimulator ON compared with OFF state.18–22 This may offer a
cohorts of patients with severe PD, all deemed suitable for possible mechanism for the improved survival among surgical
surgery, but through patient choice were managed either with patients since possible improvements in the oropharyngeal
maximal medical therapy, or undergoing STN-DBS. phase of deglutition may reduce the risk of aspiration pneumo-
Though not a randomised comparison, patients proved to be nia in patients undergoing STN-DBS.
matched in age, gender, ethnicity, duration of disease, rates of The improvements in motor function, mobility and quality of
life demonstrated with DBS2 appear crucial and may explain the
significantly reduced need for residential nursing care among
patients having surgery ( p≤0.001), since they are more likely to
remain mobile, active and independent for longer.
We considered the possibility that patients declining surgery
may have had more severe PD and either consciously or uncon-
sciously clinicians or patients were more apprehensive about
surgery. It would appear, however, that this was not the case in
this study, since there was no significant difference in duration
of disease, or dopa-equivalent medication doses between the
groups. In fact, a significantly higher proportion of patients
undergoing STN-DBS were receiving apomorphine at the time
of initial consultation suggesting that they may have suffered
with more severe PD.
The potential role of depression and the neuropsychological
Figure 2 Causes of death for medical and surgically managed effects of both PD and its management with DBS is an import-
patients. ant one. As expected, the rate of depression among the PD

20 Ngoga D, et al. J Neurol Neurosurg Psychiatry 2014;85:17–22. doi:10.1136/jnnp-2012-304715

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patients in our study was high (17% in the medical and 24% in
the surgical group) but slightly less than reported in the litera-
ture.23 There was no significant difference, however, in the inci-
dence of depression as a clinical diagnosis or treatment with
antidepressant medication in the surgical and medical patients at
initial consultation, suggesting this is unlikely to have played a
role either in the decision to consent to the procedure, or to dif-
ferences in patient outcome.
The same neurologist and neurosurgeon in a joint clinic saw
all patients in this study, reducing the potential bias that would
come from variations in explanations of procedural risk and
benefit ratios. All patients were given the same written materials
and/or audiovisual aids to inform consent to surgery, and had
access to the same PD surgery specialist nurse. This makes it
unlikely that the patients who declined surgery were selectively
discouraged by the counselling they had from the DBS team.
Patients declining surgery did not undergo formal neuro-
psychological testing. It is therefore difficult to eliminate the
possibility that baseline psychometric differences between the
two groups may have contributed to their differences in sur-
vival. However, four patients were declined surgery due to
failed psychometry, one of whom is deceased and the remaining
three are in a residential care home. In order to eliminate the
bias of this selection in the surgical group which was not per-
formed in the medical group, we included the four patients
failing psychometry considering the surgical group on an ‘inten-
tion to treat’ basis. Even with these patients included, there was
a statistically significant improvement in survival in patients
undergoing STN-DBS (Log-Rank test p=0.001).
We noted significant gender differences in the survival of
both medical and surgical patients in our study, with women
showing a higher risk of mortality than men (HR of 3.03 (95%
CI 1.47 to 6.24, p=0.003). Gender differences in both motor
and non-motor effects of PD have been described in the litera-
ture, showing that women experience more levodopa-induced
dyskinesia.24 25
The evidence on the impact of these gender differences in the
survival of patients with PD however is mixed. A large
population-based cohort of nearly 5000 incident PD pharmacy-
based patients showed an improved survival among women,26
though this study being a pharmacy-based population study is
likely to have included all severities of PD and patients with
Parkinsonism. Data from five European population-based
studies, however, does seem to support this, and also found that
the risk of death in men with PD was higher than in women.27
However, other population-based studies have demonstrated a
reduced life expectancy among women with PD.28
Though based on much smaller numbers, our study looked
specifically at a selected group of patients with severe PD. We
believe the significance of the gender differences in survival war-
rants further investigation in this group of patients.
In conclusion, improved survival is not usually among the
benefits cited when discussing the option of undergoing
STN-DBS with patients suffering from severe PD. This study
comparing patients with severe PD managed purely medically,
and those undergoing STN-DBS, shows that surgical patients
have a significantly better survival and reduced admission to
residential care, and that this effect appears independent of age,
gender, duration of disease, medication doses and rates of
treated depression at initial consultation. It also shows a signifi-
cantly increased mortality among women compared with men
in both groups.
We believe that these findings are of great interest to patients
with severe PD and doctors involved in their care, and that
Ngoga D, et al. J Neurol Neurosurg Psychiatry 2014;85:17–22. doi:10.1136/jnnp-2012-304715
Movement disorders
these findings warrant further investigation among larger patient
cohorts, recognising that randomised comparisons may no
longer be feasible.
Contributors DGN: conception and design, acquisition of data, analysis and
interpretation of data and drafting the manuscript. RM: conception and design,
acquisition of data, analysis and interpretation of data, study supervision. JK:
conception and design, acquisition of data, analysis and interpretation of data. JH:
statistical analysis, drafting the manuscript. AH: conception and design, analysis and
interpretation of data. HP: conception and design, analysis and interpretation of
data, study supervision.
Funding Funding for the acquisition of death certificates from the General Register
Office for England and Wales was obtained from the Queen Elizabeth Hospital
movement disorder charitable fund for research. This fund is generated through
individual charitable donations only and no contributions are received from corporate
sources. There has been no payment received by any of the authors to write this
article by a pharmaceutical company or other agency.
Competing interests DGN, RM, JK, and AH have received a travel grant and
accommodation from Medtronic for the attendance of a scientific meeting (ESSFN,
October 2012). HP has received support for attendance at a meeting of the
Movement Disorders Society from Medtronic (2012). James Hodson has no conflicts
of interest in relation to this work.
Ethics approval Ethics committee approval was not sought for this study. This
study is a retrospective review of data collected during the clinical follow-up of
patients treated in two different ways. No patient identifiable information has been
included in this publication.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Some additional data relating to prescribed medication
during the follow-up period for medically treated patients managed at our
institution, reasons given for declining surgery and follow-up institution for medically
treated patients are available and can be provided upon request.
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22 Ngoga D, et al. J Neurol Neurosurg Psychiatry 2014;85:17–22. doi:10.1136/jnnp-2012-304715

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Deep brain stimulation improves survival in

severe Parkinson's disease
Desire Ngoga, Rosalind Mitchell, Jamilla Kausar, James Hodson, Anwen
Harries and Hardev Pall

J Neurol Neurosurg Psychiatry 2014 85: 17-22 originally published online

July 10, 2013
doi: 10.1136/jnnp-2012-304715

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http://jnnp.bmj.com/content/85/1/17

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Collections Drugs: CNS (not psychiatric) (1734)
Parkinson's disease (601)

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