Article
作者: Duker, Andrew P. ; Metman, Leo Verhagen ; Luca, Corneliu C. ; Phibbs, Fenna T. ; Cooper, Scott E ; Jagid, Jonathan R. ; Pahwa, Rajesh ; Revuelta, Gonzalo J. ; Galifianakis, Nicholas ; Tatter, Stephen B. ; Gostkowski, Michal ; Goldberg, Edward ; Takacs, Istvan ; Leichliter, Timothy A. ; Pourfar, Michael H. ; Tagliati, Michele ; Karl, Jessica A. ; San Luciano, Marta ; House, Paul A. ; Okun, Michael S. ; Machado, Andre G. ; Neimat, Joseph ; Khandhar, Suketu M. ; Hebb, Adam O. ; Durphy, Jennifer ; Pilitsis, Julie G. ; Mogilner, Alon Y. ; Mandybur, George T. ; Foote, Kelly D. ; Zadikoff, Cindy ; Ponce, Francisco A. ; Starr, Philip A. ; Haq, Ihtsham ul ; Rosenow, Joshua M. ; Farris, Sierra M ; Whiting, Donald M. ; Tröster, Alexander I. ; Lyons, Kelly ; Schrock, Lauren E ; Ramirez-Zamora, Adolfo ; Shivacharan, Rajat S. ; Park, Michael C. ; Mamelak, Adam N. ; Vitek, Jerrold L. ; Ostrem, Jill L. ; Wharen, Robert ; Moguel-Cobos, Guillermo ; Gross, Robert E. ; Sedrak, Mark ; Nazzarro, Jules M. ; Siddiqui, Mustafa S. ; Uitti, Ryan J. ; Sani, Sepehr ; Buetefisch, Cathrin M. ; Giroux, Monique L.
Importance:The Implantable Neurostimulator for the Treatment of Parkinson’s Disease (INTREPID) trial was a randomized, double-blind, sham-controlled study of subthalamic nucleus (STN) deep brain stimulation (DBS) for the treatment of Parkinson disease (PD).
Objective:To evaluate the long-term (5-year) outcomes and safety of STN-DBS for PD.
Design, Setting, and Participants:This was a prospective, randomized (3:1), 12-week double-blind sham-controlled study at 23 movement disorder centers across the US with an open-label 5-year follow-up. Patients were implanted and followed up with the Vercise DBS system from May 2013 to December 2022. Eligibility required diagnosis of bilateral idiopathic PD with more than 5 years of motor symptoms, more than 6 hours per day of poor motor function, modified Hoehn and Yahr Scale scores higher than 2, Unified Parkinson’s Disease Rating Scale (UPDRS-III) score of 30 or higher (medication-off state), and 33% or higher improvement in UPDRS-III medication-on score.
Intervention:Bilateral STN-DBS for moderate to advanced PD.
Main Outcomes and Measures:Primary outcomes included changes in UPDRS and dyskinesia scores, quality-of-life measures, and safety assessments. Exploratory analyses included medication reduction and DBS association with motor signs.
Results:
A total of 313 patients were enrolled with 191 receiving the DBS system, and 137 participants (72%) completed the study. The study population had a mean (SD) age of 60 (7.9) years, with 139 (73%) male participants. Motor function without medication as measured by UPDRS-III improved from a mean (SD) of 42.8 (9.4) to 21.1 (10.6) at year 1 (51%; 95% CI, 49%-53%;
P
< .001) and 27.6 (11.6) at year 5 (36%; 95% CI, 33%-38%;
P
< .001). Activities of daily living without medication as measured by UPDRS-II improved from a mean (SD) of 20.6 (6.0) to 12.4 (6.1) at year 1 (41%; 95% CI, 38%-42%;
P
< .001) and 16.4 (6.5) at year 5 (22%; 95% CI, 18%-23%;
P
< .001). Dyskinesia scores decreased from 4.0 (5.1) to 1.0 (2.1) at year 1 (75%; 95% CI, 73%-75%;
P
< .001) and to 1.2 (2.1) at year 5 (70%; 95% CI, 63%-75%;
P
< .001). The levodopa equivalent dose was reduced by 28% at year 1, remaining stable at year 5 (28%; 95% CI, 26%-31%;
P
< .001). The most common serious adverse event was infection (9 participants). Ten deaths were reported, none related to the study.
Conclusions and Relevance:Although STN-DBS outcomes declined slightly, possibly due to the progressive nature of the disease, patients with PD sustained significant improvement in motor and activities of daily living scores, along with a stable reduction in anti-parkinsonian medication over the 5-year follow-up period.