Functional

This RCT compared early surgery versus continued meds for MTLE within 2 years of drug failure. Surgery yielded 73% seizure freedom at 2 years vs 0% with meds alone (p<0.001). Quality of life improved more with surgery in sensitivity analysis. The trial was stopped early (n=38 vs planned 200), so results are promising but require cautious interpretation due to limited power.

This UK multicenter RCT compared DBS plus medical therapy versus medical therapy alone in 366 advanced Parkinson's patients. At 1 year, DBS improved PDQ-39 quality of life scores by 4.7 points more than medical therapy alone, with significant benefits in mobility, ADL, and bodily discomfort domains. However, 19% had serious surgery-related adverse events including one death. DBS provides meaningful quality of life improvement but requires careful patient selection given surgical risks.

This multicenter RCT compared bilateral DBS (STN or GPi) vs best medical therapy in 255 advanced PD patients. DBS provided 4.6 more hours/day of good motor control without troubling dyskinesia vs medical therapy, with 71% vs 32% achieving clinically meaningful motor improvement. Quality of life improved significantly with DBS, but serious adverse events were more common (49 vs 15 patients). The study supports DBS efficacy in appropriately selected patients despite increased procedural risks.