Universität zu Köln

Schuepbach, W. M. Michael, Rau, Joern, Houeto, Jean-Luc, Krack, Paul ORCID: 0000-0002-3508-7295, Schnitzler, Alfons ORCID: 0000-0002-6414-7939, Schade-Brittinger, Carmen, Timmermann, Lars and Deuschl, Guenther (2014). Myths and Facts About the EARLYSTIM Study. Mov. Disord., 29 (14). S. 1742 - 1751. HOBOKEN: WILEY-BLACKWELL. ISSN 1531-8257

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Abstract

DBS of the STN improves quality of life (QoL) and motor function not only in advanced Parkinson's disease (PD), but also in PD with early motor complications, as shown in the recent EARLYSTIM study. In spite of the evidence in favor of STN-DBS, the findings of the EARLYSTIM study have recently been controversially debated. Here, we argue that a placebo or lessebo effect is unlikely to have relevantly contributed to the favorable outcome of STN-DBS in the EARLYSTIM study. The method of quantification of the placebo effect of DBS in a previous publication reveals flaws leading to implausible results, and therefore the placebo effect of DBS remains currently elusive, especially because blinding of PD patients with STN-DBS as a crucial preassumption for assessing a placebo effect is practically impossible. Moreover, we claim that the extent of such a placebo effect is most likely very small. Specific challenges of STN-DBS at an earlier stage of PD and inclusion criteria are the risk of inclusion of patients who later evolve to atypical parkinsonism, the risk of a floor effect for the benefit from DBS, the need for experienced multidisciplinary care including prevention of suicidal behavior, and the need for highly qualified long-term follow-up. The EARLYSTIM study has shown that STN-DBS may be proposed earlier on in the course of PD, as soon as motor complications start to cause relevant disability despite proper medical management. This can lead to a gain of several years of improved QoL. (C) 2014 International Parkinson and Movement Disorder Society

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schuepbach, W. M. Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Rau, Joern UNSPECIFIED UNSPECIFIED UNSPECIFIED Houeto, Jean-Luc UNSPECIFIED UNSPECIFIED UNSPECIFIED Krack, Paul UNSPECIFIED orcid.org/0000-0002-3508-7295 UNSPECIFIED Schnitzler, Alfons UNSPECIFIED orcid.org/0000-0002-6414-7939 UNSPECIFIED Schade-Brittinger, Carmen UNSPECIFIED UNSPECIFIED UNSPECIFIED Timmermann, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Deuschl, Guenther UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-421654
DOI:	10.1002/mds.26080
Journal or Publication Title:	Mov. Disord.
Volume:	29
Number:	14
Page Range:	S. 1742 - 1751
Date:	2014
Publisher:	WILEY-BLACKWELL
Place of Publication:	HOBOKEN
ISSN:	1531-8257
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DEEP-BRAIN-STIMULATION; QUALITY-OF-LIFE; PARKINSONS-DISEASE; SUBTHALAMIC NUCLEUS; SURGICAL INTERVENTIONS; CONTROLLED-TRIAL; GENE-THERAPY; OPEN-LABEL; PLACEBO; STAGE Multiple languages Clinical Neurology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42165