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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: February 20, 2013

Expiration Date: February 20, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote EducationCompany and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each EBM Focus is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1210392Y


Last week 372 articles were evaluated via DynaMed's Systematic Literature Surveillance and 235 were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Subthalamic Neurostimulation May Improve Quality of Life and Motor Function in Early Parkinson Disease
Reference: N Engl J Med 2013 Feb 14;368(7):610 (level 2 [mid-level] evidence)

Medical treatment is generally effective for the control of motor symptoms that occur early in Parkinson disease. In advanced disease, deep brain neurostimulation of the subthalamic nucleus (or globus pallidus) is recommended for patients with motor fluctuations and dyskinesia unresponsive to medical treatment. In these patients, neurostimulation has been associated with reduced motor disability and improved quality of life. This treatment is commonly delayed until over a decade into the course of the disease. A recent randomized trial investigated the effects of earlier neurostimulation treatment in patients with Parkinson disease showing early signs of motor complications.

A total of 251 patients (mean age 52 years, mean duration of disease 7.5 years) were randomized to subthalamic neurostimulation plus medical therapy vs. medical therapy alone for 2 years. All patients had fluctuations or dyskinesia present for ≤ 3 years and mild-to-moderate impairment in social and occupational functioning. Best medical therapy was assessed for each patient based on European Federation of Neurological Societies and Movement Disorder Society guidelines. Patients were excluded for dementia, major depression with suicidal thoughts, or disease duration < 4 years. Quality of life was assessed with the 39-item Parkinson Disease Questionnaire (PDQ-39) and motor symptom severity assessed with Unified Parkinson's Disease Rating Scale part III (UPDRS-III).

Subthalamic neurostimulation was associated with a 26% mean improvement in quality of life scores compared to a 1% worsening with medical therapy alone (p = 0.002). Mean motor symptom severity scores improved by 30% with neurostimulation and worsened by 12% with medical therapy alone (p < 0.001). Neurostimulation was also associated with significant improvements in levodopa-induced motor complications, time with good mobility and no dyskinesia, and with reduced daily levodopa dose. The primary outcome assessments were unblinded. Secondary blinded assessments (without intention-to-treat analysis) corroborated the primary findings. Adverse events were common with serious adverse events occurring in 55% of the neurostimulation group vs. 44% of the medical-therapy group. Serious adverse events specifically related to the surgical implantation or the neurostimulation device occurred in 18% of patients.

For more information, see the Parkinson disease topic in DynaMed.

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