Haidar Salimi Dafsari1, Luisa Weiß2, Monty Silverdale3, Alexandra Rizos4, Prashanth Reddy4, Keyoumars Ashkan4, Julian Evans3, Paul Reker2, Jan Niklas Petry-Schmelzer2, Michael Samuel4, Veerle Visser-Vandewalle5, Angelo Antonini6, Pablo Martinez-Martin7, K Ray-Chaudhuri8, Lars Timmermann9. 1. Department of Neurology, University Hospital Cologne, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. Electronic address: haidar.dafsari@uk-koeln.de. 2. Department of Neurology, University Hospital Cologne, Cologne, Germany. 3. Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom. 4. National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. 5. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany. 6. Department of Neurology, IRCCS, San Camillo, Venice, Italy. 7. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. 8. National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; Department of Basic and Clinical Neurosciences, King's College, London, United Kingdom. 9. Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany.
Abstract
BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome. HYPOTHESIS: We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome. METHODS: In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and -activities of daily living, levodopa equivalent daily dose. We dichotomized patients into "QoL responders"/"non-responders" and screened for factors associated with QoL improvement with (1) Spearman-correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions using aforementioned "responders/non-responders" as dependent variable. RESULTS: All outcomes improved significantly on follow-up. However, approximately 44% of patients were categorized as "QoL non-responders". Spearman-correlations, linear and logistic regression analyses were significant for NMSS and NMSQ but not for SCOPA-motor examination. Post-hoc, we identified specific NMS (flat moods, difficulties experiencing pleasure, pain, bladder voiding) as significant contributors to QoL outcome. CONCLUSIONS: Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies investigating motor and non-motor PD clusters may enable stratifying QoL outcomes and help predict patients' individual prospects of benefiting from DBS.
BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome. HYPOTHESIS: We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome. METHODS: In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and -activities of daily living, levodopa equivalent daily dose. We dichotomized patients into "QoL responders"/"non-responders" and screened for factors associated with QoL improvement with (1) Spearman-correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions using aforementioned "responders/non-responders" as dependent variable. RESULTS: All outcomes improved significantly on follow-up. However, approximately 44% of patients were categorized as "QoL non-responders". Spearman-correlations, linear and logistic regression analyses were significant for NMSS and NMSQ but not for SCOPA-motor examination. Post-hoc, we identified specific NMS (flat moods, difficulties experiencing pleasure, pain, bladder voiding) as significant contributors to QoL outcome. CONCLUSIONS: Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies investigating motor and non-motor PD clusters may enable stratifying QoL outcomes and help predict patients' individual prospects of benefiting from DBS.
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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