Objective: To determine the effect of subthalamic nucleus (STN) deep brain stimulation (DBS) on fatigue in PD patients.

Background: Fatigue is a common and disabling non-motor symptom (NMS) in Parkinson’s disease (PD) patients and can be evident from premotor to the palliative stage. The effect of STN DBS on fatigue is unclear.

Method: Cross-sectional one point in time analysis of 50 patients with PD who underwent STN DBS at King´s College (KCH) and Salford Royal Hospital (SAL) with fatigue scores (as measured by question number 4 from domain 2 (sleep/fatigue) of the Non-Motor Symptoms Scale (NMSS)) as a primary outcome measure. Secondary outcome measures included the PD Sleep Scale (PDSS), Scales for Outcome in PD (SCOPA)-motor examination, activities of daily living, motor complications, Hoehn and Yahr (HY) stage and changes in Levodopa Equivalent Daily Dose (LEDD). Data were collected as part of the portfolio adopted global Non-motor International Longitudinal Study (NILS; UKCRN No: 10084).

Results: 50 patients (40% female, mean age 61.09±8.70 years, mean disease duration at baseline 11.21±5.01 years with a mean follow-up period of 1.98±1.36 years) were studied.  Significant improvement in fatigue assessment of NMSS question 4 (5.20±4.53 to 3.04±3.72; p=0.001) was observed. In addition, improvements in NMSS question 5 (sleep maintenance and fragmentation; 7.56±4.34 to 2.96±4.16; p<0.001) and in NMSS domain 2 total score (sleep/fatigue; 18.64±10.53 to 9.90±9.74; p<0.001) were also significant. LEDD was reduced by 13% in this subgroup at follow up (p=0.08), but especially dopamine agonists LEDD were strongly reduced (413.19±272.98 to 302.4±155.00; p≤0.007).

Conclusion: Even though open label and non-use of validated fatigue scales, this observational analysis suggest that fatigue, along with aspects of sleep dysfunction appears to improve significantly after STN DBS with persisting benefits at a mean two years follow-up. The mechanism by which STN DBS improves fatigue remains unclear but it might be induced by the direct modulation of basal ganglia–thalamo–cortical loops through the STN nucleus. In addition, there was a significant decrease in dopaminergic drugs coinciding with the improvement of fatigue, but no significant improvement of daytime sleepiness, reaffirming that both symptoms can overlap in patients but appear to have a different pathophysiology.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-the-effect-of-bilateral-subthalamic-nucleus-deep-brain-stimulation-on-fatigue-in-parkinsons-disease/