Haidar S Dafsari1,2, Monty Silverdale3, Marian Strack1, Alexandra Rizos2, Keyoumars Ashkan2, Picabo Mahlstedt1, Lena Sachse1, Julia Steffen1, Till A Dembek1, Veerle Visser-Vandewalle4, Julian Evans3, Angelo Antonini5,6, Pablo Martinez-Martin7, K 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, United Kingdom. 3. Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom. 4. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany. 5. Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy. 6. Department of Neurosciences (DNS), Padova University, Padova, Italy. 7. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. 8. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. 9. Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany.
Abstract
BACKGROUND: The objective of this study was to investigate 24-month of effects of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on nonmotor symptoms in Parkinson's disease (PD). METHODS: In this prospective, observational, multicenter, international study including 67 PD patients undergoing bilateral STN-DBS, we examined the Non-motor Symptom Scale, Non-Motor Symptoms Questionnaire, Parkinson's Disease Questionnaire-8, Scales for Outcomes in Parkinson's Disease-motor examination, -activities of daily living, and -complications, and levodopa-equivalent daily dose preoperatively and at 5 and 24-month of follow-up. After checking distribution normality, longitudinal outcome changes were investigated with Friedman tests or repeated-measures analysis of variance and Bonferroni correction for multiple comparisons using multiple tests. Post hoc, Wilcoxon signed rank t tests were computed to compare visits. The strength of clinical responses was analyzed using effect size. Explorative Spearman correlations of change scores from baseline to 24-month follow-up were calculated for all outcomes. RESULTS: The Non-motor Symptom Scale and all other outcome parameters significantly improved from baseline to the 5-month follow-up. From 5 to 24-month, partial decrements in these gains were found. Nonetheless, comparing baseline with 24-month follow-up, significant improvements were observed for the Non-motor Symptom Scale (small effect), Scales for Outcomes in PD-motor examination showed a moderate effect, and Scales for Outcomes in Parkinson's Disease-complications and levodopa-equivalent daily dose showed large effects. Non-motor Symptom Scale change scores from baseline to 24-month follow-up correlated significantly with Parkinson's Disease Questionnaire-8, Scales for Outcomes in Parkinson's Disease-activities of daily living, and -motor complications change scores. CONCLUSIONS: This study provides evidence of beneficial effects of bilateral STN-DBS on nonmotor symptoms at 24-month follow-up. The extent of nonmotor symptom improvement was directly proportionate to improvements in quality of life, activities of daily living, and motor complications. This study underlines the importance of nonmotor symptoms for holistic assessments of DBS outcomes.
BACKGROUND: The objective of this study was to investigate 24-month of effects of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on nonmotor symptoms in Parkinson's disease (PD). METHODS: In this prospective, observational, multicenter, international study including 67 PDpatients undergoing bilateral STN-DBS, we examined the Non-motor Symptom Scale, Non-Motor Symptoms Questionnaire, Parkinson's Disease Questionnaire-8, Scales for Outcomes in Parkinson's Disease-motor examination, -activities of daily living, and -complications, and levodopa-equivalent daily dose preoperatively and at 5 and 24-month of follow-up. After checking distribution normality, longitudinal outcome changes were investigated with Friedman tests or repeated-measures analysis of variance and Bonferroni correction for multiple comparisons using multiple tests. Post hoc, Wilcoxon signed rank t tests were computed to compare visits. The strength of clinical responses was analyzed using effect size. Explorative Spearman correlations of change scores from baseline to 24-month follow-up were calculated for all outcomes. RESULTS: The Non-motor Symptom Scale and all other outcome parameters significantly improved from baseline to the 5-month follow-up. From 5 to 24-month, partial decrements in these gains were found. Nonetheless, comparing baseline with 24-month follow-up, significant improvements were observed for the Non-motor Symptom Scale (small effect), Scales for Outcomes in PD-motor examination showed a moderate effect, and Scales for Outcomes in Parkinson's Disease-complications and levodopa-equivalent daily dose showed large effects. Non-motor Symptom Scale change scores from baseline to 24-month follow-up correlated significantly with Parkinson's Disease Questionnaire-8, Scales for Outcomes in Parkinson's Disease-activities of daily living, and -motor complications change scores. CONCLUSIONS: This study provides evidence of beneficial effects of bilateral STN-DBS on nonmotor symptoms at 24-month follow-up. The extent of nonmotor symptom improvement was directly proportionate to improvements in quality of life, activities of daily living, and motor complications. This study underlines the importance of nonmotor symptoms for holistic assessments of DBS outcomes.
Authors: Sina R Potel; Sara Marceglia; Sara Meoni; Suneil K Kalia; Rubens G Cury; Elena Moro Journal: Curr Neurol Neurosci Rep Date: 2022-07-15 Impact factor: 6.030
Authors: Pablo Martinez-Martin; Anette Schrag; Daniel Weintraub; Alexandra Rizos; Carmen Rodriguez-Blazquez; Kallol Ray Chaudhuri Journal: Mov Disord Clin Pract Date: 2019-02-05
Authors: Katarzyna Smilowska; Daniel J van Wamelen; Tomasz Pietrzykowski; Alexander Calvano; Carmen Rodriguez-Blazquez; Pablo Martinez-Martin; Per Odin; K Ray Chaudhuri Journal: J Parkinsons Dis Date: 2021 Impact factor: 5.568