1
|
Dommershuijsen LJ, Darweesh SKL, Ben-Shlomo Y, Kluger BM, Bloem BR. The elephant in the room: critical reflections on mortality rates among individuals with Parkinson's disease. NPJ Parkinsons Dis 2023; 9:145. [PMID: 37857675 PMCID: PMC10587193 DOI: 10.1038/s41531-023-00588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Grants
- S.K.L. Darweesh was supported in part by a Parkinson’s Foundation—Postdoctoral Fellowship (PF-FBS-2026) and a ZonMW Veni Award (09150162010183), and serves as an associate editor of Frontiers of Neurology and as an editorial board member of Brain Sciences.
- Parkinson’s UK
- Radboud Universitair Medisch Centrum (Radboudumc)
- B.R. Bloem currently serves as Editor in Chief for the Journal of Parkinson’s disease, serves on the editorial board of Practical Neurology and Digital Biomarkers, has received honoraria from serving on the scientific advisory board for Abbvie, Biogen and UCB, has received fees for speaking at conferences from AbbVie, Zambon, Roche, GE Healthcare and Bial, and has received research support from the Netherlands Organization for Scientific Research, the Michael J Fox Foundation, UCB, Abbvie, the Stichting Parkinson Fonds, the Hersenstichting Nederland, the Parkinson’s Foundation, Verily Life Sciences, Horizon 2020, the Topsector Life Sciences and Health, the Gatsby Foundation and the Parkinson Vereniging.
Collapse
Affiliation(s)
- Lisanne J Dommershuijsen
- Center of Expertise for Parkinson and Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Sirwan K L Darweesh
- Center of Expertise for Parkinson and Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Bastiaan R Bloem
- Center of Expertise for Parkinson and Movement Disorders, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Zhang W, Dong X, Huang R. Antiparkinsonian Effects of Polyphenols: A Narrative Review with a Focus on the Modulation of the Gut-brain Axis. Pharmacol Res 2023:106787. [PMID: 37224894 DOI: 10.1016/j.phrs.2023.106787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/23/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023]
Abstract
Polyphenols, which are naturally occurring bioactive compounds in fruits and vegetables, are emerging as potential therapeutics for neurological disorders such as Parkinson's disease (PD). Polyphenols have diverse biological activities, such as anti-oxidative, anti-inflammatory, anti-apoptotic, and α-synuclein aggregation inhibitory effects, which could ameliorate PD pathogenesis. Studies have shown that polyphenols are capable of regulating the gut microbiota (GM) and its metabolites; in turn, polyphenols are extensively metabolized by the GM, resulting in the generation of bioactive secondary metabolites. These metabolites may regulate various physiological processes, including inflammatory responses, energy metabolism, intercellular communication, and host immunity. With increasing recognition of the importance of the microbiota-gut-brain axis (MGBA) in PD etiology, polyphenols have attracted growing attention as MGBA regulators. In order to address the potential therapeutic role of polyphenolic compounds in PD, we focused on MGBA. DATA AVAILABILITY: Data will be made available on request.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning PR, China
| | - Xiaoyu Dong
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning PR, China
| | - Rui Huang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning PR, China.
| |
Collapse
|
3
|
Hogg E, Frank S, Oft J, Benway B, Rashid MH, Lahiri S. Urinary Tract Infection in Parkinson’s Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:743-757. [PMID: 35147552 PMCID: PMC9108555 DOI: 10.3233/jpd-213103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson’s disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.
Collapse
Affiliation(s)
- Elliot Hogg
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel Frank
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jillian Oft
- Department of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brian Benway
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Shouri Lahiri
- Departments of Neurology, Neurosurgery, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
4
|
Artusi CA, Balestrino R, Imbalzano G, Bortolani S, Montanaro E, Tuttobene S, Fabbri M, Zibetti M, Lopiano L. Beyond 10 years of levodopa intestinal infusion experience: Analysis of mortality and its predictors. Parkinsonism Relat Disord 2019; 76:98-103. [PMID: 31610986 DOI: 10.1016/j.parkreldis.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/15/2019] [Accepted: 10/05/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although levodopa/carbidopa intestinal infusion (LCIG) proved a sustained efficacy on Parkinson's disease (PD) motor fluctuations, there is a lack of studies on mortality of LCIG patients. In this study, we aimed at analyzing mortality and its predictors in a cohort of 105 PD patients treated with LCIG for over 10 years. METHODS The death rate, death causes, mortality predictors, and serious adverse events (SAEs) were analyzed. A Cox regression model was used to estimate the influence of several demographic and clinical factors on mortality, and a binary logistic regression to evaluate the association between SAEs number and mortality. Kaplan-Meier and Log-rank test was used for a survival comparison between patients with an early drop-out (within 3 years since LCIG start) and patients continuing LCIG. RESULTS Ninety-eight advanced PD patients treated with LCIG were included. During follow-up, 34.7% of patients died at a mean age of 74.7 years, with a mean survival time of 4.6 years since LCIG start and 18 years since PD onset. The only predictor of mortality identified was the Mini Mental State Examination score at LCIG start (p:0.034). A total of 222 SAEs occurred in 87.9% of LCIG patients. The number of SAEs did not correlate with the mortality of LCIG patients (p:0.370). No survival difference exists between early drop-out patients and those continuing LCIG (p:0.341). CONCLUSION Our findings do not indicate an association between SAEs or LCIG treatment duration and mortality and highlight the importance of cognitive alterations as a mortality predictor of LCIG patients.
Collapse
Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy.
| | - Roberta Balestrino
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Sara Bortolani
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Elisa Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Sara Tuttobene
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Margherita Fabbri
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| |
Collapse
|
5
|
Oonk N, Movig K, Munster E, Koehorst-Ter Huurne K, van der Palen J, Dorresteijn L. The effect of a structured medication review on quality of life in Parkinson's disease: The study protocol. Contemp Clin Trials Commun 2019; 13:100308. [PMID: 30582067 PMCID: PMC6298904 DOI: 10.1016/j.conctc.2018.100308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/17/2018] [Accepted: 11/27/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Treatment of Parkinson's disease (PD) is symptomatic and frequently consists of complicated medication regimes. This negatively influences therapy adherence, resulting in lower benefit of treatment, drug related problems and decreased quality of life (QoL). A potential effective intervention strategy is a structured medication review, executed by community pharmacists. However, little is known about the effects on clinical endpoints like QoL, as well as on feasibility and cost-effectiveness in PD patients. OBJECTIVES To assess the effect of a structured medication review on QoL in PD patients. Secondary objectives are measurements of physical disability, activities in daily life, non-motor symptoms, health state, personal carers' QoL and cost-effectiveness. Furthermore, a better insight in the process of performing medication reviews will be obtained from the perspective of community pharmacists. METHODS In this multicenter randomized controlled trial we aim to enroll 200 PD patients from the outpatient clinic of three Dutch hospitals. Community pharmacists will perform a structured medication review in half of the assigned patients; the other half will receive usual care. Data obtained by use of six validated questionnaires will be collected at baseline and after 3 and 6 months of follow-up. Semi-structured interviews with community pharmacists will be conducted till data saturation has been reached. DISCUSSION This trial targets a high-risk patient group for whom optimizing therapy by a structured medication review might be of added value. If effectiveness is proven, this could further promote the implementation of pharmaceutical care in a primary care setting.
Collapse
Affiliation(s)
- N.G.M. Oonk
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - K.L.L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - E.M. Munster
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - K. Koehorst-Ter Huurne
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Pharmacy De Hofbraak, Haaksbergen, the Netherlands
| | - J. van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands
- Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands
| | - L.D.A. Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| |
Collapse
|
6
|
Catalán MJ, Antonini A, Calopa M, Băjenaru O, de Fábregues O, Mínguez-Castellanos A, Odin P, García-Moreno JM, Pedersen SW, Pirtošek Z, Kulisevsky J. Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence? eNeurologicalSci 2017; 8:44-53. [PMID: 29260038 PMCID: PMC5730910 DOI: 10.1016/j.ensci.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023] Open
Abstract
Advanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives. In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.
Collapse
Key Words
- APD, Advanced Parkinson's disease
- DBS, Deep brain stimulation
- Duodopa
- ICD, Impulse control disorders
- Intrajejunal infusion of levodopa/carbidopa intestinal gel
- LCIG, Levodopa-carbidopa intestinal gel
- Motor symptoms
- NMS, Non-motor symptoms
- NMSS, Non-motor symptoms scale
- Non-motor symptoms
- PD, Parkinson's disease
- PDSS, Parkinson's disease sleep scale
- PEG, Percutaneous endoscopic gastrostomy
- Parkinson's disease
- QoL, Quality of life
- Quality of life
Collapse
Affiliation(s)
- Maria José Catalán
- Parkinson and Movement Disorders Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences, IRCCS Hospital San Camillo, Venice, Italy
| | | | - Ovidiu Băjenaru
- University of Medicine and Pharmacy "Carol Davila" Bucharest - University Emergency Hospital, Department of Neurology, Bucharest, Romania
| | - Oriol de Fábregues
- Vall d'Hebron University Hospital, Neurology Service, Movement Disorders Unit, Autonomous University of Barcelona, Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Adolfo Mínguez-Castellanos
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria "ibs. Granada,", Granada, Spain
| | - Per Odin
- Skåne University Hospital, Lund University, Lund, Sweden.,Klinikum-Bremerhaven, Bremerhaven, Germany
| | | | | | | | - Jaime Kulisevsky
- Hospital Santa Creu i Sant Pau, Ciberned, Universitat Autònoma de Barcelona, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
7
|
Weaver FM, Stroupe KT, Smith B, Gonzalez B, Huo Z, Cao L, Ippolito D, Follett KA. Survival in patients with Parkinson's disease after deep brain stimulation or medical management. Mov Disord 2017; 32:1756-1763. [PMID: 29150873 DOI: 10.1002/mds.27235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Deep brain stimulation has been shown to have a significant long-term beneficial effect on motor function. However, whether it affects survival is not clear. In this study, we compared survival rates for Parkinson's disease (PD) patients who underwent deep brain stimulation (DBS) with those who were medically managed. METHODS A retrospective analysis of Veterans Affairs and Medicare administrative data of veterans with PD who received DBS and were propensity score matched to a cohort of veterans with PD who did not receive DBS between 2007-2013. RESULTS Veterans with PD who received DBS had a longer survival measured in days than a matched group of veterans who did not undergo DBS (mean = 2291.1 [standard error = 46.4] days [6.3 years] vs 2063.8 [standard error = 47.7] days [5.7 years]; P = .006; hazard ratio = 0.69 [95% confidence interval 0.56-0.85]). Mean age at death was similar for both groups (76.5 [standard deviation = 7.2] vs 75.9 [standard deviation = 8.4] years, P = .67), respectively, and the most common cause of death was PD. CONCLUSIONS DBS is associated with a modest survival advantage when compared with a matched group of patients who did not undergo DBS. Whether the survival advantage reflects a moderating influence of DBS on PD or on comorbidities that might shorten life or whether differences may be a result of unmeasured differences between groups is not known. © 2017 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Frances M Weaver
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA.,Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Kevin T Stroupe
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA.,Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Bridget Smith
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Beverly Gonzalez
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | - Zhiping Huo
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | - Lishan Cao
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | - Dolores Ippolito
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | | |
Collapse
|
8
|
Comparison of Globus Pallidus Interna and Subthalamic Nucleus in Deep Brain Stimulation for Parkinson Disease: An Institutional Experience and Review. PARKINSONS DISEASE 2017; 2017:3410820. [PMID: 28706748 PMCID: PMC5494569 DOI: 10.1155/2017/3410820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/07/2017] [Indexed: 01/17/2023]
Abstract
Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient's profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute's DBS paradigm to ensure that patients receive the optimal therapy.
Collapse
|
9
|
Rizek P, Kumar N, Jog MS. An update on the diagnosis and treatment of Parkinson disease. CMAJ 2016; 188:1157-1165. [PMID: 27221269 DOI: 10.1503/cmaj.151179] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Philippe Rizek
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Niraj Kumar
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Mandar S Jog
- Department of Clinical Neurological Sciences, Western University, London, Ont.
| |
Collapse
|
10
|
Abstract
Individuals with Parkinson's disease present a challenge to dental clinicians as this degenerative disease leads to problems accessing care and maintaining an adequate level of oral health. This article provides an overview of the implications of Parkinson's disease on oral health and explores the role of dental implants in the management of such patients.
Collapse
|
11
|
Ngoga D, Mitchell R, Kausar J, Hodson J, Harries A, Pall H. Deep brain stimulation improves survival in severe Parkinson's disease. J Neurol Neurosurg Psychiatry 2014; 85:17-22. [PMID: 23843542 DOI: 10.1136/jnnp-2012-304715] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Levodopa and other dopaminergic treatments have not had the expected effect on survival in Parkinson's disease (PD). Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to 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.
Collapse
Affiliation(s)
- Desire Ngoga
- School of Cancer Sciences, The University of Birmingham, , Birmingham, UK
| | | | | | | | | | | |
Collapse
|