Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease

Background Deep-brain stimulationis the surgical procedure of choice for patients with advanced Parkinson's disease. The globus pallidusinterna and the subthalamic nucleusare accepted targets for this procedure. We compared 24-month outcomes for patients who had undergone bilateral stimulationof the globus pallidusinterna (pallidal stimulation) or subthalamic nucleus(subthalamic stimulation). Methods At seven Veterans Affairsand six university hospitals, we randomly assigned 299 patients with idiopathic Parkinson's diseaseto undergo either pallidal stimulation(152 patients) or subthalamic stimulation(147 patients). The primary outcome was the change in motor function, as blindly assessed on the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III), while patients were receiving stimulationbut not receiving antiparkinsonian medication. Secondary outcomes included self-reported function, quality of life, neurocognitivefunction, and adverse events. Results Mean changes in the primary out...