Surgery for Parkinson’s disease: lack of reliable clinical trial evidence

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 74; no. 4; pp. 519 - 521
• Main Authors: Stowe, R L, Wheatley, K, Clarke, C E, Ives, N J, Hills, R K, Williams, A C, Daniels, J P, Gray, R
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.04.2003; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Bias; Biological and medical sciences; Brain; Care and treatment; clinical trial; Clinical trials; Clinical Trials as Topic - statistics & numerical data; Confidence intervals; DBS; deep brain stimulation; Evidence-Based Medicine - statistics & numerical data; globus pallidus; Humans; Medical sciences; Methods; Neurosurgery; Outcome Assessment (Health Care) - statistics & numerical data; Parkinson Disease - surgery; Parkinson's disease; Patients; Quality of life; randomised controlled trial; RCT; Reproducibility of Results; Short Report; Skull, brain, vascular surgery; Stereotaxic Techniques - statistics & numerical data; STN; Studies; subthalmamic nucleus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Systematic review; Unified Parkinson’s Disease Rating Scale; UPDRS; Human; Nervous system diseases; Methodology; Parkinson disease; Controlled therapeutic trial; Stereotaxia; Cerebral disorder; Metaanalysis; Treatment; Surgery; Central nervous system disease; Degenerative disease; Extrapyramidal syndrome
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.74.4.519

There has been a striking resurgence of interest in surgery for Parkinson’s disease (PD) with new targets identified and new procedures developed. This systematic review identified over 500 studies of surgery for PD published since 1990, including over 10 000 patients. However, the authors were unable to assess the value of PD surgery reliably because only seven randomised trials were identified including just 196 patients. Studies of surgery for PD have generally been of poor quality with too few patients, too short follow up, inappropriate choice of outcome measures, and lack of control groups. Much larger, randomised, controlled trials are needed to assess the longer term effects of surgery on patient rated quality of life and cost effectiveness.