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PD SURG

Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease

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Year of Publication: 2010

Authors: Adrian Williams, Steven Gill, Thelekat Varma, et al.

Journal: Lancet Neurology

Citation: Lancet Neurol 2010;9:581-91

Link: https://doi.org/10.1016/S1474-4422(10)70093-4

Clinical Question

Does DBS plus medical therapy improve QoL more than medical therapy alone in advanced PD?

Bottom Line

In patients with advanced PD on best medical therapy, DBS surgery improved quality of life (PDQ-39) by 5.0 points vs medical therapy at 1 year (P=0.001). Both STN and GPi targets used. 366 patients randomized. Published Lancet Neurology 2010 (Williams et al.). Pragmatic UK trial (Birmingham PD SURG).

Major Points

  • PDQ-39 improved: -5.0 points difference favoring DBS at 1 year (P=0.001).
  • UPDRS-III off-medication: DBS -14.2 vs medical -1.5 (P<0.001).
  • LEDD reduced 29% with DBS vs increased 5% with medical therapy.
  • 366 patients, 13 UK centers, 1:1. Pragmatic — both STN (174) and GPi (9) targets allowed.
  • AEs: 3% serious surgical complications (hemorrhage, infection). 1 death from hemorrhage.
  • Quality of life benefit sustained at 1 year across multiple PDQ-39 domains.
  • Patients recruited had advanced PD with motor complications despite optimized medical therapy.
  • Published Lancet Neurology 2010 (Williams et al.). NIHR funded.
  • Complemented EARLYSTIM (earlier DBS) — PD SURG showed benefit even in more advanced patients.
  • STN was the predominant target (95%); GPi used in a minority.

Design

Study Type: Randomized, open-label

Blinding: Open-label

Sample Size: 366

Centers: 13

Follow-up Duration: 1 year

Inclusion Criteria

  • PD per UK Brain Bank criteria
  • Inadequate symptom control with medication
  • Age-adjusted DRS-II >5
  • Fit for surgery

Exclusion Criteria

  • Not explicitly detailed

Outcomes

OutcomeTypeControlInterventionHR / OR / RRP-value
PDQ-39 summary index at 1 yearPrimary-0.3 points-5.0 points0.001
Secondary

Criticisms

  • Open-label design
  • No sham surgery control
  • 19% serious surgery-related adverse events
  • Smaller effect than 6-month trials

Funding

UK Medical Research Council, Parkinson's UK

Based on: PD SURG (Lancet Neurology, 2010)

Authors: Adrian Williams, Steven Gill, Thelekat Varma, et al.

Citation: Lancet Neurol 2010;9:581-91

Reviewed by: Ahmed Koriesh, MD

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