Haidar S Dafsari1,2, Pablo Martinez-Martin3, Alexandra Rizos2, Maja Trost4, Maria Gabriela Dos Santos Ghilardi5, Prashanth Reddy2, Anna Sauerbier2,6, Jan Niklas Petry-Schmelzer1, Milica Kramberger4, Robbert W K Borgemeester7, Michael T Barbe1, Keyoumars Ashkan2, Monty Silverdale8, Julian Evans8, Per Odin9,10, Erich Talamoni Fonoff5,11, Gereon R Fink1,12, Tove Henriksen13, Georg Ebersbach14, Zvezdan Pirtošek4, Veerle Visser-Vandewalle15, Angelo Antonini16,17, Lars Timmermann1,18, K Ray Chaudhuri2,6. 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. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. 4. Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia. 5. Department of Neurology, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. 6. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. 7. Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 8. Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom. 9. Department of Neurology, Klinikum-Bremerhaven, Bremerhaven, Germany. 10. Department of Neurology, Skane University Hospital, Lund, Sweden. 11. Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil. 12. Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany. 13. Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark. 14. Movement Disorder Clinic, Kliniken Beelitz, Beelitz-Heilstätten, Germany. 15. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany. 16. Department for Parkinson's disease, IRCCS Hospital San Camillo, Venice, Italy. 17. Department of Neuroscience, University of Padua, Padua, Italy. 18. Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany.
Abstract
OBJECTIVE: Real-life observational report of clinical efficacy of bilateral subthalamic stimulation (STN-DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD). METHODS: In this prospective, multicenter, international, real-life cohort observation study of 173 PD patients undergoing STN-DBS (n = 101), IJLI (n = 33), or APO (n = 39) were followed-up using PDQuestionnaire-8, NMSScale (NMSS), Unified PD Rating Scale (UPDRS)-III, UPDRS-IV, and levodopa equivalent daily dose (LEDD) before and 6 months after intervention. Outcome changes were analyzed with Wilcoxon signed-rank or paired t test when parametric tests were applicable. Multiple comparisons were corrected (multiple treatments/scales). Effect strengths were quantified with relative changes, effect size, and number needed to treat. Analyses were computed before and after propensity score matching, balancing demographic and clinical characteristics. RESULTS: In all groups, PDQuestionnaire-8, UPDRS-IV, and NMSS total scores improved significantly at follow-up. Levodopa equivalent daily dose was significantly reduced after STN-DBS. Explorative NMSS domain analyses resulted in distinct profiles: STN-DBS improved urinary/sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain. IJLI improved the 3 latter domains and gastrointestinal symptoms. APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain. Overall, STN-DBS and IJLI seemed favorable for NMSS total score, and APO favorable for neuropsychological/neuropsychiatric NMS and PDQuestionnaire-8 outcome. CONCLUSIONS: This is the first comparison of quality of life, nonmotor. and motor outcomes in PD patients undergoing STN-DBS, IJLI, and APO in a real-life cohort. Distinct effect profiles were identified for each treatment option. Our results highlight the importance of holistic nonmotor and motor symptoms assessments to personalize treatment choices.
OBJECTIVE: Real-life observational report of clinical efficacy of bilateral subthalamic stimulation (STN-DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD). METHODS: In this prospective, multicenter, international, real-life cohort observation study of 173 PDpatients undergoing STN-DBS (n = 101), IJLI (n = 33), or APO (n = 39) were followed-up using PDQuestionnaire-8, NMSScale (NMSS), Unified PD Rating Scale (UPDRS)-III, UPDRS-IV, and levodopa equivalent daily dose (LEDD) before and 6 months after intervention. Outcome changes were analyzed with Wilcoxon signed-rank or paired t test when parametric tests were applicable. Multiple comparisons were corrected (multiple treatments/scales). Effect strengths were quantified with relative changes, effect size, and number needed to treat. Analyses were computed before and after propensity score matching, balancing demographic and clinical characteristics. RESULTS: In all groups, PDQuestionnaire-8, UPDRS-IV, and NMSS total scores improved significantly at follow-up. Levodopa equivalent daily dose was significantly reduced after STN-DBS. Explorative NMSS domain analyses resulted in distinct profiles: STN-DBS improved urinary/sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain. IJLI improved the 3 latter domains and gastrointestinal symptoms. APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain. Overall, STN-DBS and IJLI seemed favorable for NMSS total score, and APO favorable for neuropsychological/neuropsychiatric NMS and PDQuestionnaire-8 outcome. CONCLUSIONS: This is the first comparison of quality of life, nonmotor. and motor outcomes in PDpatients undergoing STN-DBS, IJLI, and APO in a real-life cohort. Distinct effect profiles were identified for each treatment option. Our results highlight the importance of holistic nonmotor and motor symptoms assessments to personalize treatment choices.
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