Objective: To define preoperative predictive factors of short- and long-term motor outcome from a large cohort of consecutive Parkinson’s Disease (PD) patients operated on with bilateral subthalamic nucleus deep brain stimulation (STN-DBS) at the Grenoble University Hospital.

Background: When counselling for DBS surgery, it is crucial to discuss with patients the foreseen outcomes of STN-DBS surgery especially in the long-term.

Method: All consecutive PD patients operated on with bilateral STN-DBS from 1993 to 2010 were retrospectively evaluated pre-operatively (baseline), at one-year (short-term), and up to 17 years (long-term) post-operatively. Demographic variables, brain MRI and PD characteristics were collected by reviewing medical records. At baseline and one-year after surgery, the UPDRS with subscales (both in “defined-off “and “defined-on” conditions) and a standardized neuropsychological evaluation including Frontal Score, Mattis Dementia Rating Scale (MDRS), and Beck Depression Inventory were collected. In the long-term, the four parts of the UPDRS in the on-stimulation/on-medication condition were analyzed. Baseline predictive factors of good motor response to stimulation (defined as a postoperative percentage reduction >25% of the motor UPDRS score in the off-medication condition) and baseline variables associated with long-term motor impairment were calculated applying univariate and multivariate logistic and linear regressions.

Results: A total of 252 patients were included in the short-term analysis. Male sex (p=0.019), higher baseline MDRS score (p=0.020), and absence of brain MRI ischemic white matter lesions (p=0.032) were predictive of short-term good motor response to stimulation. Long-term analysis from a subgroup of 51 patients showed that higher baseline Frontal Score strongly correlated with lower motor impairment (p=0.018).

Conclusion: Baseline cognitive status and brain MRI represent strong predictive factors of short-term motor outcome in PD patients with bilateral STN-DBS. Baseline Frontal lobe function is the best predictor of STN-DBS long-term motor benefit.

References: An abstract concerning the same topic has been submitted to the XXIV World Congress on Parkinson’s Disease and Related Disorders, 16 – 19 June 2019; Montreal, Canada. (acceptance pending)

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MDS Abstracts - https://www.mdsabstracts.org/abstract/what-can-predict-short-and-long-term-outcome-of-bilateral-subthalamic-nucleus-deep-brain-stimulation-in-parkinsons-disease/