Elsa Besse-Pinot1, Bruno Pereira1, Franck Durif1, Maria Livia Fantini1, Elodie Durand1, Bérengère Debilly1, Philippe Derost1, Caroline Moreau1, Elodie Hainque1, Tiphaine Rouaud1, Alexandre Eusebio1, Isabelle Benatru1, Sophie Drapier1, Dominique Guehl1, Olivier Rascol1, David Maltête1, Ouhaïd Lagha-Boukbiza1, Caroline Giordana1, Melissa Tir1, Stéphane Thobois1, Lucie Hopes1, Cécile Hubsch1, Béchir Jarraya1, Anne-Sophie Rolland1, Jean-Christophe Corvol1, David Devos1, Ana Marques2. 1. From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France. 2. From the Neurology Department, Université Clermont Auvergne, EA7280 (E.B.-P., F.D., M.L.F., E.D., B.D., P.D., A.M.), and Biostatistics Department (B.P.), Clermont-Ferrand University Hospital, NS-Park/F-CRIN Network; Departments of Medical Pharmacology and Neurology and Movement Disorders, Referent Center of Parkinson's Disease, INSERM UMRS_1171, Licend, CHU of Lille (C.M.), and Department of Medical Pharmacology, University Hospital, Lille Neuroscience & Cognition, INSERM, UMR-S1172 (A.-S.R., D.D.), University of Lille, NS-Park/F-CRIN Network; Department of Neurology, Paris Brain Institute (ICM) (E.H., J.-C.C.), Institut Du Cerveau, INSERM CNRS, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, NS-Park/F-CRIN Network; Department of Neurology (T.R.), Nantes University Hospital, NS-Park/F-CRIN Network; Department of Neurology (A.E.), Assistance Publique Hôpitaux de Marseille, Timone University Hospital and Institut de Neurosciences de La Timone, NS-Park/F-CRIN Network; Department of Neurology (I.B.), University Poitiers, NS-Park/F-CRIN Network; Department of Neurology (S.D.), University Hospital of Rennes, NS-Park/F-CRIN Network; Institut des Maladies Neurodégénératives, Centre Expert Parkinson (D.G.), CHU de Bordeaux, NS-Park/F-CRIN Network; Parkinson Expert Center, Department of Clinical Pharmacology and Neuroscience (O.R.), Clinical Investigation Center CIC1436, NeuroToul COEN Center, Toulouse University Hospital, University of Toulouse 3, INSERM, NS-Park/F-CRIN Network; Department of Neurology (D.M.), Rouen University Hospital and University of Rouen; Laboratory of Neuronal and Neuroendocrine Differentiation and Communication (D.M.), INSERM U1239, NS-Park/F-CRIN Network, Mont-Saint-Aignan; Department of Neurology (O.L.-B.), Strasbourg University Hospital, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, NS-Park/F-CRIN Network; Department of Neurology (C.G.), Centre Hospitalier Universitaire de Nice, NS-Park/F-CRIN Network; Departments of Neurology and Neurosurgery (M.T.), Expert Centre for Parkinson's Disease, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie, Amiens University Hospital, Université de Picardie Jules Verne, NS-Park/F-CRIN Network, Amiens; Department of Neurology C (S.T.), Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, University Hospital of Lyon, Université Claude Bernard Lyon 1, CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS, NS-PARK/F-CRIN Network; Department of Neurology (L.H.), University Hospital of Nancy, NS-PARK/F-CRIN Network; Department of Neurology (C.H.), Hospital Fondation Ophtalmologique Adolphe de Rothschild, NS-PARK/F-CRIN Network; and Neuroscience Pole (B.J.), Hôpital Foch, Université Paris-Saclay (UVSQ), INSERM-CEA NeuroSpin, NS-PARK/F-CRIN Network, Paris, France. ar_marques@chu-clermontferrand.fr.
Abstract
BACKGROUND AND OBJECTIVES: To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD. METHODS: We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD-) probable RBD preoperatively. RESULTS: At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years; p = 0.02), had less motor impairment (Movement Disorder Society-sponsored version of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] III "off": 38.7 ± 16.2 vs 43.4 ± 7.1; p = 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; p < 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4; p = 0.003), and had worse quality of life (Parkinson's Disease Questionnaire-39: 33 ± 12 vs 29 ± 12; p = 0.03), as compared to pre-opRBD- patients. Both pre-opRBD+ and pre-opRBD- patients had significant MDS-UPDRS IV score decrease (-37% and -33%, respectively), MDS-UPDRS III "med 'off'/stim 'on'" score decrease (-52% and -54%), and dopaminergic treatment decrease (-52% and -49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes. CONCLUSIONS: In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery. TRIAL REGISTRATION INFORMATION: NCT02360683. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery.
BACKGROUND AND OBJECTIVES: To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD. METHODS: We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD-) probable RBD preoperatively. RESULTS: At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years; p = 0.02), had less motor impairment (Movement Disorder Society-sponsored version of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] III "off": 38.7 ± 16.2 vs 43.4 ± 7.1; p = 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; p < 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4; p = 0.003), and had worse quality of life (Parkinson's Disease Questionnaire-39: 33 ± 12 vs 29 ± 12; p = 0.03), as compared to pre-opRBD- patients. Both pre-opRBD+ and pre-opRBD- patients had significant MDS-UPDRS IV score decrease (-37% and -33%, respectively), MDS-UPDRS III "med 'off'/stim 'on'" score decrease (-52% and -54%), and dopaminergic treatment decrease (-52% and -49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes. CONCLUSIONS: In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery. TRIAL REGISTRATION INFORMATION: NCT02360683. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery.
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