Audrey Rouillé1, Stéphane Derrey2, Romain Lefaucheur3, Alaina Borden1, Damien Fetter1, Maryvonne Jan1, David Maltête4. 1. Department of Neurology, Rouen University Hospital, University of Rouen, France. 2. Department of Neurosurgery, Rouen University Hospital, University of Rouen, France. 3. Department of Neurology, Rouen University Hospital, University of Rouen, France. Electronic address: romain.lefaucheur@chu-rouen.fr. 4. Department of Neurology, Rouen University Hospital, University of Rouen, France; INSERM Unit, 1073 Rouen, France.
Abstract
BACKGROUND: Pre-operative predictive factors for optimal post-operative effect of subthalamic nucleus (STN) stimulation in Parkinson's disease (PD) have been previously reported. No study has explicitly assessed the link between excess pre-operative body weight and STN stimulation outcome. METHODS: We retrospectively compared STN stimulation outcomes of 36 PD patients with excess pre-operative body weight (group 1) and 36 matched normal-weight pre-operative (group 2) PD patients. We focused on the post-operative outcomes in the sub-group of 12 obese (group 3) PD patients. RESULTS: The post-operative motor improvement and the reduction of severity of levodopa-related complications were not statistically different between groups 1 and 2 (P>0.05). In the obese group (group 3), the axial sub-score significantly improved by 29.8% in the on-drug/on-stimulation conditions whereas the improvement was not significant in the off-drug/on-stimulation condition (22.4%, P=0.20). The post-operative Mattis Dementia Rating Score was significantly reduced in group 1 and group 3. DISCUSSION: We considered that the post-operative axial impairment observed in the obese PD patients might be essentially consecutive to disease progression and/or post-operative DBS consequences, i.e. surgical procedure or electrical stimulation itself. Moreover, it could be argued that musculoskeletal disorders associated with obesity were responsible for the incomplete efficacy of STN stimulation on axial sub-scores, by increasing gait and balance impairment. CONCLUSION: Pre-operative obesity may be regarded as a predictive clinical factor of axial and cognitive impairment after STN-DBS.
BACKGROUND: Pre-operative predictive factors for optimal post-operative effect of subthalamic nucleus (STN) stimulation in Parkinson's disease (PD) have been previously reported. No study has explicitly assessed the link between excess pre-operative body weight and STN stimulation outcome. METHODS: We retrospectively compared STN stimulation outcomes of 36 PDpatients with excess pre-operative body weight (group 1) and 36 matched normal-weight pre-operative (group 2) PDpatients. We focused on the post-operative outcomes in the sub-group of 12 obese (group 3) PDpatients. RESULTS: The post-operative motor improvement and the reduction of severity of levodopa-related complications were not statistically different between groups 1 and 2 (P>0.05). In the obese group (group 3), the axial sub-score significantly improved by 29.8% in the on-drug/on-stimulation conditions whereas the improvement was not significant in the off-drug/on-stimulation condition (22.4%, P=0.20). The post-operative Mattis Dementia Rating Score was significantly reduced in group 1 and group 3. DISCUSSION: We considered that the post-operative axial impairment observed in the obese PDpatients might be essentially consecutive to disease progression and/or post-operative DBS consequences, i.e. surgical procedure or electrical stimulation itself. Moreover, it could be argued that musculoskeletal disorders associated with obesity were responsible for the incomplete efficacy of STN stimulation on axial sub-scores, by increasing gait and balance impairment. CONCLUSION: Pre-operative obesity may be regarded as a predictive clinical factor of axial and cognitive impairment after STN-DBS.
Authors: Panagiotis Bargiotas; Lukas Eugster; Michael Oberholzer; Ines Debove; M Lenard Lachenmayer; Johannes Mathis; Claudio Pollo; W M Michael Schüpbach; Claudio L Bassetti Journal: PLoS One Date: 2017-12-18 Impact factor: 3.240