Authors' objectives:

This report aims to assess the effectiveness of deep brain stimulation (DBS) for the symptoms of Parkinson's disease.

Authors' results and conclusions: Thalamic stimulation compared to thalamotomy: A single high-quality randomised controlled trial of thalamic stimulation compared to thalamotomy in the treatment of different types of tremor was identified. This study provided some evidence that thalamic stimulation significantly improved some aspects of quality of life when compared to thalamotomy six months after surgery. Pallidal stimulation compared to pallidotomy: A single randomised controlled trial reported that pallidal stimulation and pallidotomy were not significantly different at ameliorating drug-induced dyskinesias and some Parkinson's disease symptoms three months after surgery. However, this study was limited in its research methodology because of small sample size and lack of clarity in length of follow-up. Sub-thalamic stimulation compared to ablative surgery: No studies were identified which statistically compared the effect of sub-thalamic stimulation with ablative surgery in Parkinson's disease patients. In order to assume effectiveness of DBS (pallidal, thalamic and sub-thalamic) over ablative surgery, more rigorous study and reporting is required showing long-term and short-term effectiveness. DBS compared to medical therapy: After reviewing the results of two health technology assessments (HTAs), it would appear some studies have demonstrated the added effect of DBS (thalamic, subthalamic and pallidal) over medical therapy. However, any conclusions regarding the effectiveness of DBS over medical therapy cannot be determined because of major methodological problems and poor quality of reporting in each of the studies used in the HTAs. More randomised controlled studies which look at long-term effectiveness and take full account of patients' quality of life are required in order to make a valid assessment of effectiveness.

Authors' recommendations: MSAC recommends that, based on the strength of evidence pertaining to deep brain stimulation for Parkinson's disease, interim public funding should be supported: - for patients where their response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; and - subject to the patients' participation in an appropriate controlled trial to obtain information on adverse events, longer-term patient outcomes and costs in the Australian setting. This should be carried out in consultation with appropriate groups and States, and should be limited to centres with necessary expertise.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.msac.gov.au/reports.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)