Parkinson's treatment best for younger patients

Parkinson's treatment best for "younger" patients - May 7, 2007 Reuters

NEW YORK (Reuters Health) - In individuals older than 65 with severe Parkinson's disease, deep brain stimulation reduces motor complications but does not improve quality of life, a new study finds.

But patients with severe Parkinson's disease who are younger than age 65 are apt to see both a lessening of motor disturbances and improvement in quality of life with the treatment.

Parkinson's disease is a progressive neurological disorder that causes tremor, muscle rigidity and movement problems. It is usually treated with medication. When that fails, deep brain stimulation may be an option. The technique involves electrodes implanted in the brain and electrically stimulated to ease movement problems.
"Lack of quality-of-life improvement ... raises the question of whether deep brain stimulation is appropriate for the parkinsonian population over 65 years old," Dr. Philippe-Pierre Derost from Hopital Gabriel Montpied, Clermont-Ferrand, France told Reuters Health.

Derost and associates investigated the effects, safety, and quality of life after deep brain stimulation in 87 patients with Parkinson's disease. Fifty-three of them were younger than 65 years of age, and 34 were 65 or older.

Both groups of patients experienced dramatic improvements in movement disturbances characteristic of Parkinson's disease, the authors report.

Unlike the younger patients, however, older patients showed a significant worsening on two tests that measure a person's capacity to perform daily chores.

Moreover, the results indicate, young patients fared significantly better than old patients in several quality-of-life dimensions, including mobility, activities of daily living, stigma, thinking, and communication.
In these five dimensions, young patients experienced improvements, while old patients showed only stabilization or worsening.

"The absence of improvement of quality of life in the old population was surprising since motor complications were reduced similarly in both groups of patients," Derost said.

The results of the current study "should lead us to exclude patients aged more than 65 years for deep brain stimulation," Derost suggested.

Nonetheless, some elderly patients did see favorable results, according to Derost. "Unfortunately, such predictive factors are still not identified," Derost said. "A study is being performed in our department to detect these potential predictive factors to help determine who should undergo deep brain stimulation."

SOURCE: Neurology, April 24, 2007.
REUTERS