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NEUROSURGERY AT AN EARLIER STAGE OF PARKINSON DISEASE

We compliment Schupbach et al., who report the results of a randomized controlled trial for the use of deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients at an early stage of Parkinson disease (PD).1 There are some concerns that we would like addressed.

First, previous studies have shown STN-DBS to be associated with adverse effects on cognition, mood, and behavior.2 An evaluation of STN-DBS effects on social adjustment showed that 10 of 29 patients (35%) had a new psychiatric disorder following surgery.3 Marital conflicts occurred in 17 of 24 couples, and only 9 of 16 patients went back to work after surgery. These adverse effects are only briefly addressed in the present article, even though all 10 surgically treated patients developed transient (n = 9) or permanent (n = 1) psychiatric problems.

Second, the primary outcome was quality of life assessed with the Parkinson Disease Questionnaire (PDQ-39). This is a self-report scale; therefore, the results may be …