Haidar Salimi Dafsari1, Prashanth Reddy2, Christiane Herchenbach3, Stefanie Wawro3, Jan Niklas Petry-Schmelzer3, Veerle Visser-Vandewalle4, Alexandra Rizos2, Monty Silverdale5, Keyoumars Ashkan2, Michael Samuel2, Julian Evans5, Carlo A Huber3, Gereon R Fink3, Angelo Antonini6, K Ray Chaudhuri2, Pablo Martinez-Martin7, Lars Timmermann8. 1. Department of Neurology, University Hospital Cologne, Cologne, Germany. Electronic address: haidar.dafsari@uk-koeln.de. 2. National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK. 3. Department of Neurology, University Hospital Cologne, Cologne, Germany. 4. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Germany. 5. Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Greater Manchester, UK. 6. Parkinson disease and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy. 7. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. 8. Department of Neurology, University Hospital Cologne, Cologne, Germany. Electronic address: lars.timmermann@uk-koeln.de.
Abstract
BACKGROUND: STN-DBS is well established to improve motor symptoms and quality of life in patients with PD. While non-motor symptoms are crucial for quality of life in these patients, only neuropsychiatric and neuropsychological symptoms have been systematically studied in a longitudinal design so far. However, these are only a part of the non-motor symptoms spectrum. HYPOTHESIS: We hypothesized that STN-DBS is associated with a beneficial effect on a range of non-motor symptoms. METHODS: In this multicenter, open, prospective, international study (EuroInf-study, UKCRN10084/DRKS00006735) we investigated non-motor effects of STN-DBS in "real-life" use. We evaluated Non-motor Symptom Scale, and Questionnaire, PD Questionnaire-8, Scales for Outcomes of PD motor examination and complications, and activities of daily living preoperatively and at 6 months follow-up in 60 consecutive patients (35 male, mean age: 61.6 ± 7.8 years, mean disease duration: 10.4 ± 4.2 years). RESULTS: All outcomes improved significantly at 6 months follow-up (PD Questionaire-8, p = 0.006; activities of daily living, p = 0.012; all others, p < 0.001; Wilcoxon signed-rank, respectively paired t-test; Bonferroni-correction). Post-hoc analyses of Non-motor Symptom Scale domains showed a significant reduction of sleep/fatigue and miscellaneous domains (p ≤ 0.001), perceptual problems/hallucinations (p = 0.036), and urinary (p = 0.018) scores. Effect sizes were "moderate" for Non-motor Symptom Scale, and motor complications, "large" for motor examination, and "small" for other outcomes. CONCLUSIONS: This study provides evidence that bilateral STN-DBS improves non-motor burden in patients with PD and opens the door to a more balanced evaluation of DBS outcomes. Further randomized studies are needed to confirm these findings and compare DBS non-motor effects to other invasive therapies of advanced PD.
BACKGROUND:STN-DBS is well established to improve motor symptoms and quality of life in patients with PD. While non-motor symptoms are crucial for quality of life in these patients, only neuropsychiatric and neuropsychological symptoms have been systematically studied in a longitudinal design so far. However, these are only a part of the non-motor symptoms spectrum. HYPOTHESIS: We hypothesized that STN-DBS is associated with a beneficial effect on a range of non-motor symptoms. METHODS: In this multicenter, open, prospective, international study (EuroInf-study, UKCRN10084/DRKS00006735) we investigated non-motor effects of STN-DBS in "real-life" use. We evaluated Non-motor Symptom Scale, and Questionnaire, PD Questionnaire-8, Scales for Outcomes of PD motor examination and complications, and activities of daily living preoperatively and at 6 months follow-up in 60 consecutive patients (35 male, mean age: 61.6 ± 7.8 years, mean disease duration: 10.4 ± 4.2 years). RESULTS: All outcomes improved significantly at 6 months follow-up (PD Questionaire-8, p = 0.006; activities of daily living, p = 0.012; all others, p < 0.001; Wilcoxon signed-rank, respectively paired t-test; Bonferroni-correction). Post-hoc analyses of Non-motor Symptom Scale domains showed a significant reduction of sleep/fatigue and miscellaneous domains (p ≤ 0.001), perceptual problems/hallucinations (p = 0.036), and urinary (p = 0.018) scores. Effect sizes were "moderate" for Non-motor Symptom Scale, and motor complications, "large" for motor examination, and "small" for other outcomes. CONCLUSIONS: This study provides evidence that bilateral STN-DBS improves non-motor burden in patients with PD and opens the door to a more balanced evaluation of DBS outcomes. Further randomized studies are needed to confirm these findings and compare DBS non-motor effects to other invasive therapies of advanced PD.
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