Rubens G Cury1, Ricardo Galhardoni1, Erich T Fonoff1, Maria G Dos Santos Ghilardi1, Fernanda Fonoff1, Debora Arnaut1, Martin L Myczkowski1, Marco A Marcolin1, Edson Bor-Seng-Shu1, Egberto R Barbosa1, Manoel J Teixeira1, Daniel Ciampi de Andrade2. 1. From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil. 2. From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil. ciampi@usp.br.
Abstract
OBJECTIVE: To prospectively evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the different characteristics of pain and other nonmotor symptoms (NMS) in patients with Parkinson disease (PD). METHODS: Forty-four patients with PD and refractory motor symptoms were screened for STN-DBS. Patients were evaluated before and 1 year after surgery. The primary outcome was change in pain prevalence after surgery. Secondary outcome measures were changes in motor function (Unified Parkinson's Disease Rating Scale), characteristics of pain and other NMS using specific scales and questionnaires, and quality of life. RESULTS: Forty-one patients completed the study. The prevalence of pain changed from 70% to 21% after surgery (p < 0.001). There were also significant improvements in pain intensity, NMS, and quality of life after STN-DBS (p < 0.05). Dystonic and musculoskeletal pain responded well to DBS, while central pain and neuropathic pain were not influenced by surgery. There was a strong correlation between the change in pain intensity and the improvement in quality of life (r = 0.708, p < 0.005). No correlation was found between pain improvement and preoperative response to levodopa or motor improvement during stimulation (r = 0.247, p = 0.197 and r = 0.249, p = 0.193, respectively) or with changes in other NMS. CONCLUSIONS: STN-DBS decreased pain after surgery, but had different effects in different types of PD-related pain. Motor and nonmotor symptom improvements after STN-DBS did not correlate with pain relief. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients with idiopathic PD with refractory motor fluctuations, STN-DBS decreases the prevalence of pain and improves quality of life.
OBJECTIVE: To prospectively evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the different characteristics of pain and other nonmotor symptoms (NMS) in patients with Parkinson disease (PD). METHODS: Forty-four patients with PD and refractory motor symptoms were screened for STN-DBS. Patients were evaluated before and 1 year after surgery. The primary outcome was change in pain prevalence after surgery. Secondary outcome measures were changes in motor function (Unified Parkinson's Disease Rating Scale), characteristics of pain and other NMS using specific scales and questionnaires, and quality of life. RESULTS: Forty-one patients completed the study. The prevalence of pain changed from 70% to 21% after surgery (p < 0.001). There were also significant improvements in pain intensity, NMS, and quality of life after STN-DBS (p < 0.05). Dystonic and musculoskeletal pain responded well to DBS, while central pain and neuropathic pain were not influenced by surgery. There was a strong correlation between the change in pain intensity and the improvement in quality of life (r = 0.708, p < 0.005). No correlation was found between pain improvement and preoperative response to levodopa or motor improvement during stimulation (r = 0.247, p = 0.197 and r = 0.249, p = 0.193, respectively) or with changes in other NMS. CONCLUSIONS:STN-DBSdecreased pain after surgery, but had different effects in different types of PD-related pain. Motor and nonmotor symptom improvements after STN-DBS did not correlate with pain relief. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients with idiopathic PD with refractory motor fluctuations, STN-DBS decreases the prevalence of pain and improves quality of life.
Authors: Marisa DiMarzio; Tanweer Rashid; Ileana Hancu; Eric Fiveland; Julia Prusik; Michael Gillogly; Radhika Madhavan; Suresh Joel; Jennifer Durphy; Eric Molho; Era Hanspal; Damian Shin; Julie G Pilitsis Journal: Neurosurgery Date: 2019-12-01 Impact factor: 4.654
Authors: Veit Mylius; Daniel Ciampi de Andrade; Rubens Gisbert Cury; Michael Teepker; Uwe Ehrt; Karla Maria Eggert; Serafin Beer; Jürg Kesselring; Maria Stamelou; Wolfgang H Oertel; Jens Carsten Möller; Jean-Pascal Lefaucheur Journal: Mov Disord Clin Pract Date: 2015-08-09