Objective: We sought to identify and weight clinical and demographic factors predicting bilateral STN-DBS outcomes.

Background: DBS is an established therapeutic option for treating PD patients not adequately controlled by medical therapy, however some patients fail to obtain a significant benefit. Over time, some presurgical demographic and clinical factors have been associated with the variability of the DBS outcome, yet a comprehensive evaluation of these factors is lacking.

Method: We performed an observational study including 181 PD patients treated with STN-DBS. The Wilcoxon Signed rank test was used for comparisons between pre- vs. 1-year post-surgical scores of motor score (MDS-UPDRS part III), dyskinesia (item 4.1), Off time (item 4.3), and ADL (part II). A multivariate linear regression analysis was used to evaluate the association between main clinical/demographic characteristics and the extent of STN-DBS response for outcomes proving a significant change after surgery.

Results: Comparing data before and 1 year after surgery, we observed a significant improvement of motor symptoms (P < 0.001), dyskinesia (P < .001), and daily Off time (P < .001), but not for ADL.
Sex, age, PD duration, levodopa equivalent daily dose, motor response at the levodopa challenge test (LCT), cognitive status, and axial symptoms in Off and On condition explained 15.5% of the motor improvement (R = 0.394, P = 0.011), with severity of axial symptoms in Off (Beta = 0.103, P = 0.012) and On condition (Beta = −0.132, P = 0.043) being the strongest predictors of improvement.
The same model explained 21.2% of the daily Off time improvement (R = 0.460, P < 0.001), with the severity of axial symptoms in Off condition and pre-surgical motor response to levodopa (Beta = 1.633, P = 0.023) being the strongest predictor of improvement (Beta = 0.538, P < 0.001).
The dyskinesia improvement was not significantly explained by the model, with disease duration being the only significant predictor of variance (Beta = 0.054, P = 0.010).

Conclusion: Our findings highlight the relevant role of axial symptoms as predictors of STN-DBS outcome, together with the commonly used pre-surgical motor response to LCT. A deeper phenotypic characterization of complicated PD patients is warranted for a fine-grained stratification of candidates and the best choice among different device-aided therapies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predictive-factors-for-a-favorable-stn-dbs-outcome-in-parkinsons-disease-the-role-of-axial-symptoms/