Haidar S Dafsari1, Maria Gabriela Dos Santos Ghilardi2, Veerle Visser-Vandewalle3, Alexandra Rizos4, Keyoumars Ashkan4, Monty Silverdale5, Julian Evans5, Raquel C R Martinez6, Rubens G Cury2, Stefanie T Jost7, Michael T Barbe7, Gereon R Fink8, Angelo Antonini9, K Ray-Chaudhuri10, Pablo Martinez-Martin11, Erich Talamoni Fonoff6, Lars Timmermann12. 1. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. Electronic address: haidar.dafsari@uk-koeln.de. 2. Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil. 3. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany. 4. National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. 5. Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom. 6. Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil. 7. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany. 8. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany. 9. Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy; Department of Neuroscience, University of Padua, Padua, Italy. 10. National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. 11. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. 12. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany.
Abstract
BACKGROUND: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects. OBJECTIVE: To compare nonmotor effects of STN-DBS and GPi-DBS. METHODS: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. RESULTS: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. CONCLUSIONS: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.
BACKGROUND: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects. OBJECTIVE: To compare nonmotor effects of STN-DBS and GPi-DBS. METHODS: In this prospective, observational, multicenter study including 60 PDpatients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. RESULTS: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. CONCLUSIONS: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.
Authors: Stefanie T Jost; Veerle Visser-Vandewalle; Alexandra Rizos; Philipp A Loehrer; Monty Silverdale; Julian Evans; Michael Samuel; Jan Niklas Petry-Schmelzer; Anna Sauerbier; Alexandra Gronostay; Michael T Barbe; Gereon R Fink; Keyoumars Ashkan; Angelo Antonini; Pablo Martinez-Martin; K Ray Chaudhuri; Lars Timmermann; Haidar S Dafsari Journal: NPJ Parkinsons Dis Date: 2021-06-08
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