Haidar Salimi Dafsari1,2, Paul Reker1, Monty Silverdale3, Prashanth Reddy2, Manuela Pilleri4, Pablo Martinez-Martin5, Alexandra Rizos2, Estelle Perrier1, Luisa Weiß1, Keyoumars Ashkan2, Michael Samuel2, Julian Evans3, Veerle Visser-Vandewalle6, Angelo Antonini4,7, Kallol Ray-Chaudhuri2,8, Lars Timmermann1,9. 1. Department of Neurology, University Hospital Cologne, Cologne, Germany. 2. National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK. 3. Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. 4. Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy. 5. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. 6. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany. 7. Department of Neuroscience, University of Padua, Padua, Italy. 8. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 9. Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany.
Abstract
OBJECTIVE: The optimal timing of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) is a topic of ongoing debate. In patients with short disease duration an improvement of quality of life (QoL) has been demonstrated for patients aged younger than 61 years. However, this has not been systematically investigated in older patients yet. We hypothesized that patients aged 61 years or older experience a significant QoL improvement after STN-DBS with no difference in effect sizes for groups of patients with short and longer disease duration. MATERIALS AND METHODS: From four centers (Cologne, London, Manchester, Venice) we identified "older patients" aged 61 years or older with short (≤8 years) or longer disease duration and compared QoL, motor impairment, complications, medication requirements, and Mini-Mental State Examination (MMSE) on baseline and five months after surgery. RESULTS: Mean age/disease duration in 21 subjects with shorter disease duration were 65.5/6.3 years compared to 66.8/14.6 in 33 subjects with longer disease duration. The short disease duration group was affected by less baseline motor complications (p = 0.002). QoL in the short/longer disease duration group improved by 35/20% (p = 0.010/p = 0.006), motor complications by 40/44% (p = 0.018/p < 0.001), and medication requirements by 51/49% (both p < 0.001). MMSE remained unchanged in both groups. CONCLUSION: Patients aged 61 years or older benefited from STN-DBS regardless of short (≤8 years) or longer (>8 years) disease duration. Our results contribute to the debate about DBS selection criteria and timing and call for prospective confirmation in a larger cohort.
OBJECTIVE: The optimal timing of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) is a topic of ongoing debate. In patients with short disease duration an improvement of quality of life (QoL) has been demonstrated for patients aged younger than 61 years. However, this has not been systematically investigated in older patients yet. We hypothesized that patients aged 61 years or older experience a significant QoL improvement after STN-DBS with no difference in effect sizes for groups of patients with short and longer disease duration. MATERIALS AND METHODS: From four centers (Cologne, London, Manchester, Venice) we identified "older patients" aged 61 years or older with short (≤8 years) or longer disease duration and compared QoL, motor impairment, complications, medication requirements, and Mini-Mental State Examination (MMSE) on baseline and five months after surgery. RESULTS: Mean age/disease duration in 21 subjects with shorter disease duration were 65.5/6.3 years compared to 66.8/14.6 in 33 subjects with longer disease duration. The short disease duration group was affected by less baseline motor complications (p = 0.002). QoL in the short/longer disease duration group improved by 35/20% (p = 0.010/p = 0.006), motor complications by 40/44% (p = 0.018/p < 0.001), and medication requirements by 51/49% (both p < 0.001). MMSE remained unchanged in both groups. CONCLUSION: Patients aged 61 years or older benefited from STN-DBS regardless of short (≤8 years) or longer (>8 years) disease duration. Our results contribute to the debate about DBS selection criteria and timing and call for prospective confirmation in a larger cohort.
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Authors: Stefanie T Jost; Lena Strobel; Alexandra Rizos; Philipp A Loehrer; Keyoumars Ashkan; Julian Evans; Franz Rosenkranz; Michael T Barbe; Gereon R Fink; Jeremy Franklin; Anna Sauerbier; Christopher Nimsky; Afsar Sattari; K Ray Chaudhuri; Angelo Antonini; Lars Timmermann; Pablo Martinez-Martin; Monty Silverdale; Elke Kalbe; Veerle Visser-Vandewalle; Haidar S Dafsari Journal: NPJ Parkinsons Dis Date: 2022-04-20
Authors: Anna Sauerbier; Philipp Loehrer; Stefanie T Jost; Shania Heil; Jan N Petry-Schmelzer; Johanna Herberg; Pia Bachon; Salima Aloui; Alexandra Gronostay; Lisa Klingelhoefer; J Carlos Baldermann; Daniel Huys; Christopher Nimsky; Michael T Barbe; Gereon R Fink; Pablo Martinez-Martin; K Ray Chaudhuri; Veerle Visser-Vandewalle; Lars Timmermann; Daniel Weintraub; Haidar S Dafsari Journal: J Neurol Neurosurg Psychiatry Date: 2021-09-11 Impact factor: 10.154